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Maxillary sinus

  1. #1
    Post Maxillary sinus
    Medical Coding Books
    This is a patient who has had previous maxillary antrostomy. The op report reads as follows:

    . The maxillary antrostomy was widely paten; therefore, it was felt that this was not necessary to re-enlarge. Mucopurulent material was encountered within the maxillary sinus, which was then suctioned. An Afrin pledget was then placed in the ethmoid cavity.

    31267 and 31256 don't really seem to fit since the antrostomy isn't being redone. However material is being removed which leads you back to 31267.

    Any thoughts on this one. Does anyone know of a code that does not include the antrostomy but does include the removal of material from the maxillary sinus.

  2. #2
    Albany, New York
    Have you looked at 31233?
    Karen Maloney, CPC
    Data Quality Specialist

  3. #3
    Thanks for the help. That was what I needed.

  4. Default
    Hello, I am a little late with response, but in reading CPT 31233, it is a diagnostic procedure only, there is no tissue removal; it is an endoscopic view of the maxillary sinus, a trocar puncture is made either thru the internal meatus or canine fossa, the endoscope is then inserted to view the maxillary sinus, nothing else is done.

    In reviewing CPT 31267, I would utilize this code for what you described; using 31233 does not accurately represent the amount of work your MD did and greatly reduces your reimbursement.

    CT ENT

  5. Default Otolaryngologist/CPC
    Don't know the entire context - but merely suctioning secretions from a maxillary sinus via a patent ostium involves such minimal work (particularly if done along with other reportable FESS codes) that I would question whether any additional reimbursement for that is appropriate. 31267 is not a reportable code for what is described here.

  6. #6
    31231 is the correct cpt code-it is diagnostic and INCLUDES viewing of the interior nasal cavity, opening of the sinuses(maxillary, sphenoid,frontal, ethmoid), the meatus, turbinates and spheno-ethmoid recess per AMA. So all the doctor did was view the sinuses and can not bill for the suctioning b/c that is included. For 31267 to be used, in opening would have had to been performed along with removal of tissue from the sinus. For 31233 to have been used, a puncture would have hd to been made in inferior meatus.

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