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Jaime2680

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Can anyone help me sort out the difference between 31090 and the endoscopic codes 31267,31267,31287. My provider is insisting I bill it 31090 versus the endoscopic. notes reflect endoscopy though. Is 31090 an open procedure. also it states unilateral can a 50 modifier be added?
 
31090 - this description below is a general description of the procedure done from supercoder.com

When the patient is appropriately prepped and anesthetized, the provider chooses an appropriate route such as
intranasal, intraoral, or through an incision to advance to the diseased sinus. He uses forceps, curettes, and other
appropriate instruments to remove diseased tissues from the sinus and sends samples to pathology for further
analysis. He then closes the incision with a simple repair or repairs it in layers depending upon the route. He performs
the service in three sinuses on the same side of the face.

31090 is an open procedure which consists of entering 3 or more sinuses and based on code selections you gave the physician only entered 2

I would say you are correct in your choice to code the endoscopic codes 31267, 31287 based on the small amount of info given....you did note 31267 twice is that stating he did both sides of the maxillary sinus and one side of the sephnoid sinus

I hope someone with more knowledge of this can either support or correct what I've put down
 
Interestingly the RVU breakdown I have for the 31090 includes the use of an endoscope so i'm not completely sure. However must be 3 on a single side to be reported. It cannot be reported bilateral unless 3 different sinuses on each side (6 -8 total).

Sounds more like 31267-50 & 31287-RT/LT if the duplicate 31267 means done on both sides.
 
I agree with the last poster.

CPT 31090 describes a sinusotomy, which by definition is an "incision of the sinus" (-otomy = incision). This describes is an open (non-endoscopic) procedure involving at least 3 of the 4 paranasal sinuses (maxillary, ethmoid, frontal or sphenoid) on the same side. If the procedure was done via endoscopy, then you cannot bill 31090. You would bill the appropriate codes from 31254-31288.

Hope that helps!
 
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