Wiki Denial for Max Antros W/RMVL 31267

[vibyers]

One of our cases were recently audited and came back denying 31267 stating "if he/she exclusively removed tissue from the ostium and not the maxillary sinus itself, 31267 is not substantiated and is there for denied as not documented" Are they considering the infundibulum as part of the ostium?

Any help would be appreciated.

OP Notes State:
Angled scopes and backbiting forceps were used to take down any remaining uncinate process in the natural ostium of the left maxillary sinus now identified. This was enlarged posteriorly. Thick inspissated mucous was encountered in the inferior maxillary sinus and this was suctioned out and then irrigated with sterile saline. Some diseased tissue from the infundibulum of maxillary sinus was removed as well.

Angled scopes were used to take down any remaining uncinate process at this point, identifying the natural ostium of the maxillary sinus and enlarging this posteriorly. As on the other side, diseased tissue was removed from the infundibulum. The maxillary sinus and some inspissated mucous was removed inferiorly from the maxillary sinus although this side was somewhat less involved than the left.

 

[nsteinhauser]

It sounds like they are considering the infundibulum and the ostium NOT part of the maxillary sinus itself.
The cpt book reads "...with removal of tissue from maxillary sinus." I haven't had a chance to look for strict anatomical definitions of where the maxillary sinus starts and stops, i.e., does it end at the ostium and then become part of the nose/uncinate process? That may be how the auditor is looking at it. If that is the case, then 31237 would be the appropriate code.
Diagram attached. Hope this helps.

 

[vibyers]

+This is super helpful. Thank you!!