How To Use CPT Code 31225

CPT 31225 describes a surgical procedure known as maxillectomy, which involves the removal of all or part of the maxilla (upper jaw) without orbital exenteration. This article will provide an overview of CPT code 31225, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 31225?

CPT 31225 is a code used to describe the surgical procedure known as maxillectomy. This procedure involves the removal of all or part of the maxilla, which is the upper jaw. It is important to note that this code specifically refers to maxillectomy without orbital exenteration, which is the removal of the contents of the orbit, such as the eye or part of the bony orbit, to treat large orbital tumors.

2. Official Description

The official description of CPT code 31225 is: ‘Maxillectomy; without orbital exenteration.’

3. Procedure

1. During a maxillectomy, the healthcare provider performs an intraoral incision to expose the maxilla.
2. The provider then fractures the maxilla intraoperatively to remove all or part of the diseased bone.
3. If necessary, the provider may also remove the diseased sinus contents.
4. After the removal of the maxilla and sinus contents, the provider may use separately reportable skin grafts or other methods, such as splinting, to block the mouth from the surgical wound.
5. The provider then closes all the skin incisions with sutures in layers.

4. Qualifying circumstances

CPT code 31225 is used when a maxillectomy is performed without orbital exenteration. This procedure is typically performed to treat tumors, infections, or chronic granulomatous diseases affecting the maxilla. It is important to note that this code represents a unilateral service, meaning it is performed on one side. If the procedure is performed bilaterally, the appropriate modifier should be appended.

5. When to use CPT code 31225

CPT code 31225 should be used when a maxillectomy is performed without orbital exenteration. It is important to ensure that the procedure meets the specific criteria outlined in the code description. If orbital exenteration is performed along with the maxillectomy, a different code should be used (such as CPT code 31230).

6. Documentation requirements

To support a claim for CPT code 31225, the healthcare provider must document the following information:

• Patient’s diagnosis necessitating the maxillectomy
• Details of the procedure, including the specific approach used (e.g., intraoral incision)
• Extent of the maxillectomy (partial or complete)
• Any additional procedures performed, such as removal of sinus contents
• Use of separately reportable skin grafts or other methods to block the mouth from the surgical wound
• Details of the closure technique

7. Billing guidelines

When billing for CPT code 31225, it is important to ensure that the procedure performed meets the specific criteria outlined in the code description. This code represents a unilateral service, so if the procedure is performed bilaterally, the appropriate modifier should be appended. It is also important to note that CPT code 31225 should not be reported with CPT codes 31230 or any other codes that include orbital exenteration.

8. Historical information

CPT code 31225 was added to the Current Procedural Terminology system on January 1, 1990. The code has not undergone any updates since its addition. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Similar codes to CPT code 31225

Five similar codes to CPT code 31225 include:

• CPT code 31230: This code is used when maxillectomy is performed with orbital exenteration.
• CPT code 31231: This code is used for radical maxillectomy, which involves the removal of the maxilla, orbital contents, and other structures.
• CPT code 31235: This code is used for endoscopic maxillectomy, which is a less invasive approach to removing the maxilla using an endoscope.
• CPT code 31237: This code is used for endoscopic radical maxillectomy, which involves the removal of the maxilla, orbital contents, and other structures using an endoscope.
• CPT code 31238: This code is used for endoscopic medial maxillectomy, which involves the removal of the medial wall of the maxillary sinus.

9. Examples

1. A healthcare provider performs a maxillectomy without orbital exenteration to remove a tumor affecting the maxilla in a patient.
2. A maxillofacial surgeon performs a maxillectomy without orbital exenteration to treat a chronic infection in the maxilla.
3. A patient undergoes a maxillectomy without orbital exenteration to address a granulomatous disease affecting the maxilla.
4. A maxillofacial surgeon performs a maxillectomy without orbital exenteration to remove a portion of the maxilla affected by a tumor, followed by reconstruction with a skin graft.
5. A maxillofacial surgeon performs a maxillectomy without orbital exenteration to remove a portion of the maxilla affected by a tumor, followed by closure of the incision with sutures.
6. A patient undergoes a maxillectomy without orbital exenteration to address a chronic infection in the maxilla, followed by closure of the incision with sutures.
7. A maxillofacial surgeon performs a maxillectomy without orbital exenteration to remove a portion of the maxilla affected by a granulomatous disease, followed by reconstruction with a skin graft.
8. A patient undergoes a maxillectomy without orbital exenteration to remove a portion of the maxilla affected by a granulomatous disease, followed by closure of the incision with sutures.
9. A healthcare provider performs a maxillectomy without orbital exenteration to remove a tumor affecting the maxilla in a patient, followed by closure of the incision with sutures.