How To Use CPT Code 31237

CPT 31237 refers to a nasal/sinus endoscopy procedure involving biopsy, polypectomy, or debridement. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 31237.

1. What is CPT 31237?

CPT 31237 is a medical code used to describe a specific type of nasal/sinus endoscopy procedure that involves biopsy, polypectomy, or debridement. This code is used by healthcare providers to accurately document and bill for this particular procedure.

2. 31237 CPT code description

The official description of CPT code 31237 is: “Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)”.

3. Procedure

The CPT 31237 procedure involves the following steps:

  1. The patient is appropriately prepped and anesthetized.
  2. The provider inserts an endoscope into the nose and examines the entire nasal cavity.
  3. Depending on the patient’s condition, the provider performs a biopsy, polypectomy, or debridement using appropriate surgical instruments.
  4. The provider withdraws the endoscope and places cotton pledgets at the site to avoid further bleeding.

4. Qualifying circumstances

Patients eligible to receive CPT 31237 services are those who require a nasal/sinus endoscopy for the purpose of biopsy, polypectomy, or debridement. This may include patients with chronic sinusitis, nasal polyps, or other conditions that require examination and treatment of the nasal cavity. The provider must determine the necessity of the procedure based on the patient’s medical history, symptoms, and diagnostic findings.

5. When to use CPT code 31237

It is appropriate to bill CPT 31237 when the provider performs a nasal/sinus endoscopy with biopsy, polypectomy, or debridement as a separate procedure. This code should not be reported separately when the provider performs nasal endoscopy as part of a larger, related service. Additionally, CPT 31237 represents a unilateral service, meaning it is performed on one side. If the procedure is performed bilaterally, modifier 50 should be appended, or modifiers RT/LT can be used depending on payer preference.

6. Documentation requirements

To support a claim for CPT 31237, the following information should be documented:

  • Patient’s medical history and symptoms that justify the need for the procedure.
  • Diagnostic findings that support the decision to perform the procedure.
  • Detailed description of the procedure, including the type of endoscope used, the specific surgical instruments employed, and the steps taken during the procedure.
  • Any complications or adverse events that occurred during the procedure.
  • Post-procedure care instructions and follow-up plan.

7. Billing guidelines

When billing for CPT 31237, it is important to follow the appropriate guidelines and rules. This code should not be reported in conjunction with certain other codes when performed on the ipsilateral side, as specified in the CPT code description. Additionally, if the procedure is performed bilaterally, modifier 50 should be appended, or modifiers RT/LT can be used depending on payer preference.

8. Historical information

CPT 31237 was added to the Current Procedural Terminology system on January 1, 1994. There have been no updates to the code since its addition.

9. Similar codes to CPT 31237

Five similar codes to CPT 31237 and how they differentiate are:

  1. CPT 31238: This code involves control of nasal hemorrhage during an endoscopic procedure.
  2. CPT 31253: This code describes a more extensive endoscopic sinus surgery involving multiple sinuses.
  3. CPT 31254: This code is used for endoscopic sinus surgery involving the ethmoid sinus.
  4. CPT 31255: This code refers to endoscopic sinus surgery involving the maxillary sinus.
  5. CPT 31256: This code is used for endoscopic sinus surgery involving the sphenoid sinus.

10. Examples

Here are 10 detailed examples of CPT code 31237 procedures:

  1. A patient with chronic sinusitis undergoes a nasal/sinus endoscopy with debridement to remove inflamed tissue.
  2. A patient with a nasal polyp undergoes a nasal/sinus endoscopy with polypectomy to remove the polyp.
  3. A patient with suspected nasal cancer undergoes a nasal/sinus endoscopy with biopsy to obtain a tissue sample for diagnostic examination.
  4. A patient with recurrent sinus infections undergoes a nasal/sinus endoscopy with debridement to remove infected tissue.
  5. A patient with nasal obstruction undergoes a nasal/sinus endoscopy with polypectomy to remove a polyp causing the obstruction.
  6. A patient with a history of nasal bleeding undergoes a nasal/sinus endoscopy with biopsy to determine the cause of the bleeding.
  7. A patient with a deviated septum undergoes a nasal/sinus endoscopy with debridement to remove excess tissue and improve airflow.
  8. A patient with a suspected fungal infection undergoes a nasal/sinus endoscopy with biopsy to obtain a tissue sample for diagnostic examination.
  9. A patient with a history of nasal trauma undergoes a nasal/sinus endoscopy with debridement to remove damaged tissue and promote healing.
  10. A patient with a suspected nasal tumor undergoes a nasal/sinus endoscopy with biopsy to obtain a tissue sample for diagnostic examination.

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