Otolaryngology Coding Alert

Question: An otolaryngologist documented a procedure as:
  left endoscopic maxillary antrostomy with biopsy, sinus tissue contents.
  left maxillary sinusoscopy. On the superbill, the surgeon coded 31256 and wrote as an extra procedure "maxillary sinoscopy." I think the otolaryngologist is correct not to bill 31267
because he did not remove tissue. But how should I code the sinusoscopy?


Georgia Subscriber


Answer: The otolaryngologist actually does deserve credit for 31267 (Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus). Because the surgeon takes a biopsy of the maxillary sinus and a biopsy involves taking tissue, the procedure qualifies as 31267. Code 31267 does not require complete tissue removal, just tissue removal.

When the otolaryngologist performs a maxillary antrostomy and doesn't remove any tissue, such as a biopsy or polyp, you should instead assign 31256 (Nasal/sinus endoscopy, surgical, with maxillary antrostomy).

On the other hand, you should not code the sinuscopy. Surgical endoscopy (such as 31256-31267) includes diagnostic endoscopy (for instance 31233, Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy [via inferior meatus or canine fossa puncture]). Answers to You Be the Coder and Reader Questions provided by Barbara J. Cobuzzi, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions in Shrewsbury, N.J.; Victoria S. Jackson, CEO of Omni Management in Lake Forest, Calif.; and Charles F. Koopmann Jr., MD, MHSA, professor and associate chair at the University of Michigan's department of otolaryngology in Ann Arbor.