Otolaryngology Coding Alert

Question: How should I report a bilateral antrostomy? Is 31267-50 correct?

California Subscriber Answer: If documentation shows that your otolaryngologist removed tissue from the maxillary sinus, you should use 31267 (Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus). For maxillary antrostomy without tissue removal, you should instead report 31256 (Nasal/sinus endoscopy, surgical, with maxillary antrostomy).
 
Code 31267, like all functional endoscopic sinus surgery  codes (31237-31294), is a unilateral procedure. Therefore, when your otolaryngologist performs the same FESS procedure on both sides, you should use modifier -50 (Bilateral procedure) to indicate a bilateral procedure. 
 
Depending on the insurer, you may report the bilateral procedure on one or two lines. Most private payers prefer two lines:
  31267
  31267-50.
 Medicare carriers typically require a one-line submission:
  31267-50.
 
When you report either of the above combinations, you bill for maxillary antrostomy with tissue removal on both sides. If your otolaryngologist only removes tissue from one side, you should instead append modifier -59 (Distinct procedural service) to the lesser-valued code - the maxillary antrostomy (31256). This modifier tells the payer that you are billing for the second maxillary antrostomy because the procedure is a distinct procedural service (separate site) from the primary procedure (maxillary antrostomy with tissue removal) (31267).