Otolaryngology Coding Alert

Question: When an otolaryngologist suctions purulent mucoid material from any of the sinuses during an endoscopy, is this considered removal of tissue and reported with codes 31254/31255, 31267, or 31288? What code should I report when the surgeon is only suctioning the purulent mucous from the sinus?

Louisiana Subscriber

Answer: No, suctioning mucus is not considered tissue removal. When the otolaryngologist performs nasal or sinus endoscopy and aspirates only purulent material from the area they are examining, you should report CPT^® code 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)).

You should not report CPT^® codes 31254 (Nasal/sinus endoscopy, surgical with ethmoidectomy; partial (anterior)), 31255 (… with ethmoidectomy; total (anterior and posterior)), 31267 (Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus), or 31288 (… with sphenoidotomy; with removal of tissue from the sphenoid sinus) unless your physician performs an ethmoidectomy or sinusotomy. And if they suction purulent material from the sinuses during these procedures, it is part of the procedure itself and not separately billable.