Otolaryngology Coding Alert

Question: An otolaryngologist makes a bicoronal incision down to the paracranium. He elevates the osteopathic flap. The frontal sinus contents reveal severe mucosal disease completely filling the frontal sinuses bilaterally with multiple septations and loculations. He uses a cutting bar to take down these multiple septations and locutions and removes all mucosal disease from the frontal sinus region.
 
What frontal sinusotomy code should I use for the above portion of the operative report? The otolaryngologist also performs a bilateral anterior ethmoidectomy and harvests an adipose tissue graft from the patient's right lower quadrant to replace the frontal sinus mucosa.

Georgia Subscriber

Answer: You should report the bilateral obliterative frontal sinusotomy as 31085-50 (Sinusotomy frontal; obliterative, with osteoplastic flap, coronal incision; bilateral procedure) with 473.1 (Chronic frontal sinusitis).
 
CPT divides the open frontal sinusotomy codes into obliterative (31080-31085) and nonobliterative codes (31086-31087). Because the otolaryngologist in your example replaces the diseased mucosa with other material - autologous abdomen fat - you should use an obliterative code from the 31080-31085 series.
 
To choose the right obliterative frontal sinusotomy code, you must know:
 1. Whether the otolaryngologist creates an osteoplastic flap (31084-31085). If he doesn't, use  codes 31080-31081.
 2. Where the surgeon makes the incision. Report 31080 or 31084 for a brow incision. For a coronal incision, report 31081 or 31085. The otolaryngologist in the operative report creates an osteoplastic flap and uses a bicoronal incision. Therefore, the correct code is 31085 appended with modifier -50 to indicate a bilateral procedure.
 
Also: You would code the bilateral anterior ethmoidectomy with 31254-50 (Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial [anterior]) and ICD-9 code 473.2 (Chronic ethmoidal sinusitis). For the tissue graft, use 20926 (Tissue grafts, other [e.g., paratenon, fat, dermis]) and 473.1.
 
Tip: You don't need to report the graft as a multiple procedure with modifier -51 (Multiple procedure). Code 20926 is modifier -51 exempt.