Otolaryngology Coding Alert

Question: When should I report sinusectomy codes? When a surgeon suctions purulent mucoid material from any of the sinuses, is this considered removal of tissue and reported with codes 31254/31255, 31267, or 31288?

Texas Subscriber

Answer: Report 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) when the otolaryngologist performs nasal or sinus endoscopy, and only suctions the purulent mucous from the patient's sinus. If she performs an endoscopic nasal/sinus debridement -- for instance,removing necrotic material or tissue, in addition to suctioning mucus or pus -- you should bill 31237 (Nasal/ sinus endoscopy, surgical; with biopsy, polypectomy ordebridement [separate procedure]).

Pointer: The surgeon must perform a sinusostomy or ethmoidectomy before you can report 31254 (Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial [anterior]), 31255 (...with ethmoidectomy, total [anterior and posterior]), 31267 (...with maxillary antrostomy; with removal of tissue from maxillary sinus), or 31288 (...with sphenoidotomy; with removal of tissue from the sphenoid sinus). Suctioning of purulent material from sinuses during any of these nasal/sinus endoscopies is part of the procedure itself. If only purulent material, mucous and/or pus is removed in the maxillary sinuses or sphenoid sinuses, only 31256 (Nasal/sinus endoscopy, surgical, with maxillary antrostomy) or 31287 (Nasal/sinus endoscopy, surgical, with sphenoidotomy) may be coded respectively. In order to be able to code 31267 or 31288, the physician must remove actual tissue, a polyp, necrotic tissue, a cyst,  etc. from the maxillary or sphenoid sinuses, respectively.