Otolaryngology Coding Alert

Question: Our surgeon performed a revised total ethmoidectomy. From my understanding, that means the ethmoids are now gone. How should we code this?

New Mexico Subscriber

Answer: Revision ethmoidectomies are more common than you might think. During the initial surgery, the ethmoids are not removed; instead, they are opened, the surgeon creates ostomies, and then removes any polyps. The procedure might need to be done again, which is what the revision is.

CPT^® does not include a code specifically for a revision. Your choices are either 31254 (Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial [anterior]) for a partial or 31255 (…with ethmoidectomy, total [anterior and posterior]) for a total ethmoidectomy.

If the surgery is more complicated because a prior ethmoidectomy has been performed – and you have documentation to support the current surgery’s complications – you might be justified in appending modifier 22 (Increased procedural service) and potentially gaining more reimbursement. Be prepared to appeal a claim with modifier 22, if necessary.

Also note: A revision ethmoidectomy supports the medical necessity of stereotactic CT assisted navigation. If the surgeon used this and has clear documentation, you can also report add-on code +61782 (Stereotactic computer-assisted [navigational] procedure; cranial, extradural [List separately in addition to code for primary procedure]).