Otolaryngology Coding Alert

Question: Can I report code 31267 when the surgeon only removes tissue from the ostium following a maxillary antrostomy — or does tissue need to be removed from the maxillary sinus?

Maine Subscriber

Answer: There are no authoritative sources (CPT^® Assistant, specialty societies, or otherwise) that instruct you that you can’t report 31267 if you exclusively remove tissue from the ostium and not the maxillary sinus itself. Actually the following guidance not to report 31267 is simply based on the code description itself: (Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus). If tissue removal from the ostium occurs during the maxillary antrostomy, but it does not extend into the maxillary sinus, then you should stick with code 31256.

Furthermore, you should be especially wary of appending modifier 22 (Increased procedural services) to 31256 for extra work involved in the removal of tissue from the ostium. This service, by definition, is included in the procedure description of code 31256.