Otolaryngology Coding Alert

Question: Can codes 31255, 31295, and 31297 be used with modifier 50? Can they be reported on the same claim as 31296?

Arizona Subscriber

Answer: According to CPT^® guidelines at the beginning of the endoscopy section, “Codes 31233-31297 are used to report unilateral procedures unless otherwise specified.” Therefore, you can append modifier 50 (Bilateral procedure) to 31255 (Nasal/sinus endoscopy, surgical; with ethmoidectomy, total [anterior and posterior]), 31295 (… with dilation of maxillary sinus ostium [e.g., balloon dilation], transnasal or via canine fossa), or 31297 (… with dilation of sphenoid sinus ostium [e.g., balloon dilation]) if the physician documentation supports it.

Each of the endoscopy codes you mention can also be reported with 31296 (…with dilation of frontal sinus ostium [e.g., balloon dilation]) without CCI edit restrictions.