Otolaryngology Coding Alert

Question: My ENT doctor did bilateral frontal sinuplasty and nothing else on the frontal sinuses, so I was thinking 31296-50 should be the correct code. But in his operative report, he states bilateral maxillary sinuplasty with partical removal of ucinectomy on the left. Am I correct in thinking he cannot charge for the sinuplasty because he did the partial ucinectomy on the left?  Can he charge a 31295 for the right and a 31256 on the left?

Kentucky Subscriber

Answer: Yes, you can. Interestingly, the Correct Coding Initiative (CCI) does not bundle 31256 and 31295, but because of the notations in the AMA CPT manual, you cannot code these two codes together unless they are performed on different sides.

So, because the otolaryngologist performed these procedures on different sites, you would unbundle them with modifier 59 (Distinct procedural service). You should bill the balloon code for one side with modifier 59 and the maxillary antrostomy for the other side, so your claim will look like this:

• 31256-LT -- Nasal/sinus endoscopy, surgical, with maxillary antrostomy; Left side
• 31295-59-RT -- ... with dilation of maxillary sinus ostium (e.g., balloon dilation), transnasal or via canine fossa; Right side

Modifiers LT and RT are further clarification, but you need the 59 to break the bundle.

Note: Had these procedures occured on the same side, you are correct: you cannot bill them together.