Otolaryngology Coding Alert

Question: How should I report a bilateral total ethmoidectomy with a right frontal sinusotomy? I am debating between 31253-50 and 31255-50, 31276-51.

Michigan Subscriber

Answer: In Volume 20, Issue 3 of the Otolaryngology Coding Alert, we covered the most common new FESS code combinations in the article “Nail Down Correct Usage of New Bundled FESS Codes.” However, you’ll see that this particular scenario was not addressed.

You know that you cannot combine 31255 (Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior)) and 31276 (Nasal/sinus endoscopy, surgical, with frontal sinus exploration, including removal of tissue from frontal sinus, when performed) due to Correct Coding Initiative (CCI) bundling restrictions. Additionally, you should not consider modifier 59 (Distinct Procedural Service) or XS (Separate Site) on 31276 since the provider performs the service on the same side as one of the two ethmoidectomy sites.

Instead, you should report these services using the following new frontal endoscopic sinus surgery (FESS) codes: 31253 (Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed) and 31255 (Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior)).

Specifically, you should report a bilateral total ethmoidectomy with a right frontal sinusotomy as the following:

• 31253-RT (Right Side)
• 31255-59-LT (Left Side).

This means that you will report the right-sided total ethmoidectomy with frontal sinusotomy as 31253-RT, and you will report the left-sided total ethmoidectomy as 31255 with modifier 59 and LT. The 59 modifier is necessary due to the modifier “1” CCI edit between codes 31255 and 31253. You will append modifier 59 (or XS if the patient has Medicare Part B) to 31255 (column 2 code).