How To Use CPT Code 31267

CPT 31267 is a surgical procedure code for nasal/sinus endoscopy with maxillary antrostomy and tissue removal from the maxillary sinus. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 31267.

1. What is CPT 31267?

CPT 31267 is a surgical procedure code used to describe a nasal/sinus endoscopy with maxillary antrostomy and removal of tissue from the maxillary sinus. This procedure is performed to treat chronic maxillary sinusitis and involves the insertion of an endoscope into the nasal cavity, accessing the maxillary sinus, and removing diseased tissues.

2. 31267 CPT code description

The official description of CPT code 31267 is: “Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus.”

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. The provider inserts a rigid or flexible endoscope into the nasal cavity.
3. The provider shifts the middle meatus, i.e., tunnel-like structure toward the middle of the nose.
4. The provider advances to the uncinate process and dislocates the free higher and central edges of the uncinate process to enter the maxillary sinus ostium.
5. The provider enlarges the maxillary sinus opening using cutting forceps.
6. The provider removes mucosa and cultures the contents from the maxillary sinus, sending them to pathology for further analysis.
7. The provider retains the position of the uncinate process.
8. The provider withdraws the endoscope and packs the nose with gauze to prevent any further bleeding.

4. Qualifying circumstances

Patients eligible to receive CPT code 31267 services are those diagnosed with chronic maxillary sinusitis who have not responded to conservative treatments such as medications and nasal irrigation. The procedure is typically performed when the patient’s symptoms persist despite these treatments, or when there is evidence of complications such as recurrent infections, nasal polyps, or cysts in the maxillary sinus.

5. When to use CPT code 31267

It is appropriate to bill the 31267 CPT code when the provider performs a nasal/sinus endoscopy with maxillary antrostomy and removal of tissue from the maxillary sinus to treat chronic maxillary sinusitis. This code represents a unilateral service, meaning performed on one side of the nasal cavity. Append modifier 50 or RT/LT, depending on payer preference, if the provider performs the procedure bilaterally.

6. Documentation requirements

To support a claim for CPT 31267, the following information should be documented in the patient’s medical record:

• Diagnosis of chronic maxillary sinusitis
• Conservative treatments attempted and their outcomes
• Indications for the procedure, such as persistent symptoms or complications
• Details of the procedure, including the use of an endoscope, maxillary antrostomy, and tissue removal
• Side of the nasal cavity on which the procedure was performed (unilateral or bilateral)
• Pathology report for the removed tissue, if applicable
• Postoperative care instructions and follow-up plan

7. Billing guidelines

When billing for CPT code 31267, it is important to follow payer-specific guidelines and rules. Some payers may require the use of modifier 50 or RT/LT to indicate bilateral procedures. Additionally, do not report CPT 31267 in conjunction with CPT codes 31233, 31237, 31256, or 31295 when performed on the ipsilateral side.

8. Historical information

CPT 31267 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 31267

Five similar codes to CPT 31267 and how they differentiate from CPT 31267 are:

1. CPT 31256: This code is used when the provider performs a nasal/sinus endoscopy with maxillary antrostomy without removing tissues from the sinus.
2. CPT 31233: This code describes a nasal/sinus endoscopy with biopsy, polypectomy, or debridement, but without maxillary antrostomy.
3. CPT 31237: This code is for a nasal/sinus endoscopy with frontal sinus exploration, including the removal of tissue.
4. CPT 31295: This code represents a nasal/sinus endoscopy with balloon dilation of the maxillary sinus ostium, without tissue removal.
5. CPT 31267: This code is used when the provider removes a cyst or polyp from the maxillary sinus during the nasal/sinus endoscopy with maxillary antrostomy.

10. Examples

Here are 10 detailed examples of CPT code 31267 procedures:

1. A patient with chronic maxillary sinusitis undergoes a nasal/sinus endoscopy with maxillary antrostomy and removal of polyps from the maxillary sinus.
2. A patient with recurrent maxillary sinus infections has a nasal/sinus endoscopy with maxillary antrostomy and removal of infected tissue from the maxillary sinus.
3. A patient with a cyst in the maxillary sinus undergoes a nasal/sinus endoscopy with maxillary antrostomy and cyst removal.
4. A patient with chronic maxillary sinusitis and nasal polyps has a nasal/sinus endoscopy with maxillary antrostomy and polypectomy.
5. A patient with complications from chronic maxillary sinusitis undergoes a nasal/sinus endoscopy with maxillary antrostomy and removal of diseased tissue from the maxillary sinus.
6. A patient with persistent symptoms of maxillary sinusitis despite conservative treatments has a nasal/sinus endoscopy with maxillary antrostomy and tissue removal from the maxillary sinus.
7. A patient with chronic maxillary sinusitis and a history of failed conservative treatments undergoes a nasal/sinus endoscopy with maxillary antrostomy and removal of diseased tissue from the maxillary sinus.
8. A patient with chronic maxillary sinusitis and evidence of complications such as recurrent infections undergoes a nasal/sinus endoscopy with maxillary antrostomy and removal of infected tissue from the maxillary sinus.
9. A patient with chronic maxillary sinusitis and nasal polyps undergoes a nasal/sinus endoscopy with maxillary antrostomy and removal of polyps from the maxillary sinus.
10. A patient with a history of chronic maxillary sinusitis and failed conservative treatments undergoes a nasal/sinus endoscopy with maxillary antrostomy and removal of diseased tissue from the maxillary sinus.