Otolaryngology Coding Alert

Question: 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. May I report 31276?

New York Subscriber

Answer: Maybe. While working on the frontal sinus, if the otolaryngologist opens up the ostium to allow the patient to breathe better, the physician performs a frontal sinusostomy (31276, Nasal/sinus endoscopy, surgical with frontal sinus exploration, with or without removal of tissue from frontal sinus). Just looking into the frontal sinus does not fulfill 31276. But you indicate that the surgeon fractures and subluxes the agger nasi cells to establish patency (air flow). Therefore, he may have performed 31276, but without reading the full op note, it is hard to fully determine.

Before using 31276, check your otolaryngologist's notes to make sure he documents the dissection and removal of obstructing frontal recess cells, polyps or scar tissue and intersinus septi from the ethmoid dome and skull base. As evidence of opening up the ostium, government and payer auditors may also expect to see bone mentioned in the operative report and even in the pathology report. But the pathologist may not note bone, especially if the surgeon used a micro-debrider, which mixes tissues from different sinuses.

If the otolaryngologist does not open up the ostium, do not report 31276 for the "look see." You would instead bill 31255 (Nasal/sinus endoscopy, surgical; with ethmoidectomy, total [anterior and posterior]) for the total ethmoidectomy, which includes 31254 (... with ethmoidectomy, partial [anterior]).