Clinical Indicators: Diagnostic Nasal Endoscopy

*Note: Separate Procedure by CPT definition means the code should not be reported with other procedures of which it is a part; in this case, therapeutic nasal/sinus endoscopic procedures.

1. History (one or more required)
   1. Obstructed nasal breathing
   2. Epistaxis, anterior or posterior, either active or past history
   3. Facial pain or headache consistent with sinonasal origin
   4. Persistant nasal drainage (anterior or posterior) of more than
   5. 10 day duration or when an endoscopic-directed culture is desired (severe symptoms, immunocompromise, suspected suppurative complication of rhinosinusitis, failure to respond to treatment, etc)
   6. Sinus barotrauma (after flying or diving)
   7. External nasal trauma to rule out septal hematoma
   8. Watery rhinorrhea suggestive of cerebrospinal fluid leak
   9. Persistent sinus abnormality on diagnostic imaging study
   10. History suggestive of nasal foreign body or mass
   11. Follow-up examination of known nasal, sinus, or nasopharyngeal neoplasm
   12. Anosmia or hyposmia
   13. Follow-up examination following endoscopic sinus surgery
   14. Snoring and/or sleep apnea
   15. Oro -antral (oro-maxillary) fistula
   16. Assess for interval response to medical therapy in patients with chronic and recurrent acute sinusitis
   17. Monitor for recurrence of nasal polyps
2. Physical Examination (one required)
   1. Anterior rhinoscopy insufficient to account for symptoms.
   2. Abnormal anterior rhinoscopy requiring more thorough nasal evaluation, including, but not limited to suspected chronic rhinosinusitis, sinonasal polyposis, neoplasm, and/or foreign body

Post-Procedure Observations

1. Nasal bleeding.
2. New nasal or facial pain.

Outcome Review

1. Document procedure, including pertinent anatomic sites with relevant findings of areas described in introduction language of endoscopy section of the CPT book, and any complications on the day of procedure.

Associated ICD-9 Diagnostic Codes (Representative, but not all-inclusive, codes)

• 160.0 Carcinoma nasal cavity
• 160.1 Carcinoma auditory tube, middle ear, mastoid
• 160.2 Carcinoma maxillary sinus
• 160.3 Carcinoma ethmoid sinus
• 160.4 Carcinoma frontal sinus
• 160.5 Carcinoma sphenoid sinus
• 160.8 Carcinoma sinuses, other sites, overlapping
• 160.9 Carcinoma sinuses, NOS 172 Malignant melanoma
• 212.0 Benign neoplasm of nasal cavity and accessory sinuses
• 231.8 Carcinoma in-situ, nasal, sinus
• 349.81 Rhinorrhea, cerebrospinal (fluid)
• 352.0 Disorders of olfaction
• 376.21 Thyrotoxic exophthalmos
• 448.0 Hereditary hemorrhagic telangiectasia
• 461.0 Acute sinusitis, maxillary
• 461.1 Acute sinusitis, frontal
• 461.2 Acute sinusitis, ethmoidal
• 461.3 Acute sinusitis, spehnoidal
• 461.9 Acute sinusitis
• 470 Deviated nasal septum, acquired
• 471.0 Nasal polyposis
• 471.1 Polypoid degeneration
• 471.8 Polyp of sinus
• 472.2 Chronic rhinitis
• 473.0 Chronic maxillary sinusitis
• 473.1 Chronic frontal sinusitis
• 473.2 Chronic ethmoidal sinusitis
• 473.3 Chronic sphenoidal sinusitis
• 473.8 Chronic pansinusitis
• 473.9 Sinusitis, chronic (may also code for specific sinus)
• 477.0 Allergic rhinitis due to pollen
• 477.1 Allergic rhinitis due to pollen
• 477.2 Allergic rhinitis due to food
• 477.8 Allergic rhinitis due to other allergen
• 477.9 Allergic/vasomotor rhinitis
• 478.0 Hypertrophy of nasal turbinates
• 478.1 Other diseases of nasal cavity (including nasal obstruction and rhinorrhea)
• 478.19 Other disease of nasal cavity and sinuses (abscess of nose, cyst or mucocele of sinus, necrosis of nose, ulcer of nose, rhinolith,)
• 738.0 Nasal deformity, acquired
• 748.0 Choanal atresia
• 748.1 Cleft nose
• 754 Deviated nasal septum, congenital
• 781.01 Disturbances of sensation of smell
• 784.0 Headache
• 784.7 Epistaxis
• 802.0 Fracture, nasal (bones), closed
• 802.1 Fracture, nasal (bones), open
• 932 Foreign body in nose
• 993.1 Barotrauma, sinus

Associated ICD-10-CM Diagnostic Codes (Representative, but not all-inclusive, codes)

• C30.0 Malignant neoplasm of nasal cavity
• C30.1 Malignant neoplasm of middle ear
• C31.0 Malignant neoplasm of maxillary sinus
• C31.1 Malignant neoplasm of ethmoidal sinus
• C31.2 Malignant neoplasm of frontal sinus
• C31.3 Malignant neoplasm of sphenoid sinus
• C31.8 Malignant neoplasm of overlapping sites of accessory sinuses
• D02.3 Carcinoma in situ of other parts of respiratory system
• D14.0 Benign neoplasm of middle ear, nasal cavity, and accessory sinuses
• G96.0 Cerebrospinal fluid leak
• G52.0 Disorders of olfactory nerve
• J01.00 Acute maxillary sinusitis, unspecified
• J01.01 Acute recurrent maxillary sinusitis
• J01.10 Acute frontal sinusitis, unspecified
• J01.11 Acute recurrent frontal sinusitis
• J01.20 Acute ethmoidal sinusitis, unspecified
• J01.21 Acute recurrent ethmoidal sinusitis
• J01.30 Acute sphenoidal sinusitis, unspecified
• J01.31 Acute recurrent sphenoidal sinusitis
• J01.40 Acute pansinusitis, unspecified
• J01.41 Acute recurrent pansinusitis
• J01.80 Other acute sinusitis
• J01.81 Other recurrent acute sinusitis
• J33.0 Polyp of nasal cavity
• J33.1 Polypoid sinus degeneration
• J33.8 Other polyp of sinus
• J32.0 Chronic maxillary sinusitis
• J32.1 Chronic frontal sinusitis
• J32.2 Chronic ethmoidal sinusitis
• J32.3 Chronic sphenoidal sinusitis
• J32.4 Chronic pansinusitis
• J32.8 Other chronic sinusitis
• J30.1 Allergic rhinitis due to pollen
• J30.5 Allergic rhinitis due to food
• J30.81 Allergic rhinitis due to animal (cat)(dog) hair and dander
• J30.9 Other Allergic rhinitis
• J34.3 Hypertrophy of nasal turbinates
• M95.0 Acquired deformity of nose
• Q30.0 Choanal atresia
• Q30.1 Agnesis and underdevelopment of nose
• Q30.2 Fissured, notched and cleft nose
• Q30.3 Congenital perforated nasal septum
• R43.8 Other disturbances of smell and taste
• R51 Headache
• G44.1 Vascular headache, not elsewhere classified
• R04.0 Epistaxis
• S02.2XXA Fracture of nasal bones, initial encounter for closed fracture
• S02.2XXB Fracture of nasal bones, initial encounter for open fracture
• S02.2XXD Fracture of nasal bones, subsequent encounter for fracture with routine healing
• S02.XXG Fracture of nasal bones, subsequent encounter for fracture with delayed healing
• S02.XXK Fracture of nasal bones, subsequent encounter for fracture with nonunioin
• S02.XXS Fracture of nasal bones, sequela
• T17.0XXA Foreign body in nasal sinus, initial encounter
• T17.0XXD Foreign body in nasal sinus, subsequent encounter
• T17.0XXS Foreign body in nasal sinus, sequela
• T70.1XXA Sinus barotrauma, initial encounter
• T70.1XXD Sinus barotrauma, subsequent encounter
• T70.1XXS Sinus barotrauma, sequela

Patient Information

Nasal endoscopy is done when there may be a condition or disease in the nose or sinuses that is not adequately visualized on routine examination. The nose may be sprayed with a decongestant and topical anesthetic before insertion of a rigid and/or flexible endoscope. The procedure can be performed on both adults and children, although the latter may require general anesthesia. The throat may be numb for several minutes following use of an anesthetic.

Important Disclaimer Notice (Updated 8/7/14)

Clinical indicators for otolaryngology serve as a checklist for practitioners and a quality care review tool for clinical departments. The American Academy of Otolaryngology—Head and Neck Surgery, Inc. and Foundation (AAO-HNS/F) Clinical Indicators are intended as suggestions, not rules, and should be modified by users when deemed medically necessary. In no sense do they represent a standard of care. The applicability of an indicator for a procedure must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical indicators will not ensure successful treatment in every situation. The AAO-HNS/F emphasizes that these clinical indicators should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. The AAO-HNS/F is not responsible for treatment decisions or care provided by individual physicians. Clinical indicators are not intended to and should not be treated as legal, medical, or business advice.

CPT five-digit codes, nomenclature and other data are copyright 2014 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein.

Updated January 2015

© 2014 American Academy of Otolaryngology-Head and Neck Surgery.