CPT for ENT: Nasal Sinus Endoscopy

There have been a number of member inquiries on the correct usage of CPT® codes 31233 Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture) and 31235 Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoidal face or cannulation of ostium). Some who perform endoscopic exams after the postoperative global period to view the interior of maxillary or sphenoid sinuses through existing surgically created patent sinusotomies are reporting 31233 or 31235 (or, perhaps both).

When the physician performs endoscopic exams postoperatively (to view the interior of maxillary or sphenoid sinuses through existing surgically created patent sinusotomies), the Academy’s position is that only CPT code 31231 Nasal/sinus endoscopy, diagnostic, unilateral or bilateral (separate procedure) is appropriate. Our rationale is that CPT codes 31233 and 31235 require a puncture or trocar cannulation prior to placing the scope into the sinus. CPT code 31231 is bilateral while the CPT codes 31233 and 31235 are unilateral. The use of CPT code 31233 or 31235 to report diagnostic sinus endoscopy performed via an existing and patent opening into the maxillary or sphenoid sinus is incorrect.

Reviewed October 2023

IMPORTANT DISCLAIMER NOTICE

CPT FOR ENT ARTICLES ARE A COLLABORATIVE EFFORT BETWEEN THE ACADEMY’S TEAM OF CPT ADVISORS, MEMBERS OF THE PHYSICIAN PAYMENT POLICY (3P) WORKGROUP, AND HEALTH POLICY STAFF. ARTICLES ARE DEVELOPED TO ADDRESS COMMON CODING QUESTIONS RECEIVED BY THE HEALTH POLICY TEAM, AS WELL AS TO CLARIFY CODING CHANGES AND CORRECT CODING PRINCIPLES FOR FREQUENTLY REPORTED ENT PROCEDURES. THESE ARTICLES ARE NOT INTENDED AS LEGAL, MEDICAL, OR BUSINESS ADVICE AND ARE NOT A GUARANTEE OF REIMBURSEMENT. THE INFORMATION IS ALSO NOT MEANT TO SERVE AS THE DEFINITIVE OR SOLE AUTHORITY ON BILLING AND CODING ISSUES. THE APPLICABILITY OF AAO-HNS BILLING AND CODING GUIDANCE FOR A PARTICULAR PROCEDURE, MUST BE DETERMINED BY THE RESPONSIBLE PHYSICIAN IN LIGHT OF ALL THE CIRCUMSTANCES PRESENTED BY THE INDIVIDUAL PATIENT. YOU SHOULD CONSULT WITH YOUR OWN ADVISORS AS WELL AS MEDICARE OR PRIVATE CARRIERS IN MAKING ANY DECISIONS ABOUT HOW TO BILL AND CODE PARTICULAR SERVICES OR PROCEDURES.