Otolaryngology Coding Alert

Question: I’m working on a case where a patient presents for nasal endoscopy with a bilateral ethmoidectomy and maxillary antrostomy. The surgeon dilated the anterior cavities, and cerebrospinal fluid in the left and right ethmoid regions was noted. They then removed three polyps from the maxillary sinus bilaterally, followed by the maxillary antrostomy. I currently have this coded as 31290 and 31256. However, I am unsure if 31254 might apply as well. What CPT^® codes would you report for this service?

Texas Subscriber

Answer: The procedure performed includes more than what’s indicated in 31256 (Nasal/sinus endoscopy, surgical, with maxillary antrostomy). The removal of polyps from the maxillary sinuses means you have the documentation to support 31267 (… with removal of tissue from maxillary sinus) with modifier 50 (Bilateral procedure).

For the repair of the ethmoidal cerebrospinal fluid leak, you will report 31290 (Nasal/sinus endoscopy, surgical, with repair of cerebrospinal fluid leak; ethmoid region). When performing a National Correct Coding Initiative (NCCI) edits check, you will see 31290 technically bundles into 31254 (Nasal/sinus endoscopy, surgical with ethmoidectomy; partial (anterior)) with a modifier “1” indicator. Despite the fact that 31290 is the column 2 code, you are allowed to submit whichever code yields the higher number of relative value units (RVUs). In this case, 31290 reimburses significantly more than 31254. Assuming the cerebrospinal fluid (CSF) leak repair was performed bilaterally, you will append modifier 50 to 31290.