Otolaryngology Coding Alert

Expert reveals frontal sinus surgery requirements

Frontal sinus surgery code 31276 has long proven to be one of the most confusing otolaryngology codes. To shed some light on what this procedure really entails, coding experts offer the following advice for reporting frontal sinus exploration.

Know What Frontal Sinusotomy Requires

If the descriptor "frontal sinus exploration" makes you question what 31276 (Nasal/sinus endoscopy, surgical with frontal sinus exploration, with or without removal of tissue from frontal sinus) includes, you're not alone.
 
After trying unsuccessfully to find written clinical coding guidelines for the surgical endoscopy code, Allison Radford, CPC, at University Surgical Associates in Louisville, Ky., asked, "When the otolaryngologist inspects the frontal recess with a scope and also fractures and subluxes the agger nasi cells, should I report a frontal sinus exploration?"
 
Advice: You should report 31276 when your otolaryngologist documents that he performed specific frontal sinusotomy procedures, says Charles F. Koopmann Jr., MD, MHSA, professor and associate chair at the University of Michigan's department of otolaryngology in Ann Arbor. When CMS assigned relative value units (RVUs) to 31276, the representatives based the decision on data that otolaryngologists supplied to CPT for this code, he says. Code 31276's intraservice work includes a review of CPT anatomy with removal of obstructing frontal recess cells, polyps, or scar tissue. If necessary, the surgeon may remove intersinus septi from the dome of the ethmoid and skull base. The physician may also remove ostetic bone between the frontal sinus and a supraorbital ethmoid cell.
 
Tip: Check your otolaryngologist's notes to make sure he or she documents the dissection and removal of obstructing frontal recess cells, polyps or scar tissue and intersinus septi from the ethmoid dome and skull base.
 
If pertinent, documentation may also describe ostetic bone removal between the frontal sinus and a supraorbital ethmoid cell. The physician's notes may also indicate any work that the otolaryngologist performs inside the frontal sinus ostium for enlargement or other reasons.
 
Remember, code 31276 describes a complicated procedure, Koopmann says. The time the unilateral procedure takes - typically one hour or more - and the high RVUs (14.52) that the National Physician Fee Schedule assigns to 31276 support the procedure's difficulty. So, make sure you code frontal sinus exploration for frontal recess dissection, not endoscopy.

Don't Confuse 31255 With 31276

Even though 31276's descriptor contains "frontal sinus exploration," don't think of 31276 simply as a frontal sinus exploration. Code 31276 actually refers to frontal sinusotomy.
 
You shouldn't report a frontal sinus exploration (31276) unless the otolaryngologist meets the above criteria, Koopmann says.

Test Your Knowledge

Try your 31276 skill with the following operative report: The otolaryngologist uses a scope to inspect the frontal recess. While performing ethmoidectomy and antrostomy, he also fractures and subluxes the agger nasi cells to establish patency.
 
In this case, the otolaryngologist's frontal recess description is especially useful for determining the services he actually performed, Koopmann says.
 
The report reflects that the otolaryngologist does not clean out frontal recess cells, polyps or scar tissue. Nor does the surgeon go into the frontal sinus. Therefore, you should bill 31255 (Nasal/sinus endoscopy, surgical; with ethmoidectomy, total [anterior and posterior]) for the total ethmoidectomy, which includes 31254 (... with ethmoidectomy, partial [anterior]), Koopmann says.