Hi Candice,
Thank you so much for answering me. It sounds like I am on the same page as you. Do you have any documentation (web site info,
coding book info) that I can use to support this? Something that I can show to the doctor? If you have the time I'm pasting the op note that I am specifically referring to with the codes the doctor gave. DX was chronic sinusitis in frontal and ethmoid. No tissue taken from frontal, only ethmoid. Thank you!!!!
PROCEDURE PERFORMED:
1. Bilateral endoscopic sinus surgery including right and left
anterior-posterior ethmoidectomy, CPT code 31255.
2. Right and left frontal sinusotomy (balloon technique), CPT code
31276.
(anesthesia)...ethmoid sinus on both sides. We first addressed the left sinus system.
With direct endoscopic visualization, the balloon dilatation system was
introduced under the head of left middle turbinate. A guidewire was
advanced into the left frontal sinus and positioning was confirmed with
transillumination. Then, the 6 x 16 mm dilatation catheter was
advanced over the guidewire to serially dilate the frontoethmoid tract.
This was done in three stages, each time inflating the balloon to 12
atmospheres of pressure. Next, the anterior ethmoid was opened at the
bulla using Blakesley forceps. Ethmoid cavity was developed from
anterior to posterior with care to preserve the lamina paprycea and
fovea ethmoidalis. Polypoid mucosal disease was found all throughout
the ethmoid sinus. The specimen was sent for routine pathologic
review. Attention was then directed to the right nasal passage. The
0-degree endoscope was introduced and balloon dilatation system was
introduced under the head of the middle turbinate. Guidewire was
passed several times in an attempt to find the native frontoethmoid
tract but initially this could not be accomplished. Inspection of the
region did reveal some buildup of polypoid tissue superiorly at the
region approximately where the frontal access would be expected. This
polypoid tissue was removed with upbiting Blakesley forceps.
Ethmoidectomy was initiated at the ethmoid bulla using Blakesley
forceps. Polypoid tissues were removed and the dissection was
continued from anterior to posterior along the ethmoid cavity. Care
was taken to preserve the lamina paprycea and fovea ethmoidalis. On
both sides, the cavity was enlarged and made smoother using the
microdebrider system fitted with 4 mm Tricut blade and operated at 3000
RPM. I again introduced the balloon dilatation system at the right
middle meatus and did succeed to pass the illuminated guidewire into
the right frontal sinus. This was confirmed by transillumination. The
frontoethmoid tract was then dilated serially using the 6 x 16 mm
dilatation catheter each time inflating to 12 atmospheres pressure.
The wounds were irrigated with saline and reinspected to assure there
was satisfactory hemostasis. There was minor bloody ooze on both.....(surgery ended)
