How To Use CPT Code 31256

CPT 31256 describes a surgical procedure involving nasal/sinus endoscopy with maxillary antrostomy. This article will cover the official description, procedure details, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 31256?

CPT 31256 is a code used to describe a surgical procedure that involves the use of an endoscope to examine the nasal cavity and perform a maxillary antrostomy. During this procedure, the provider inserts a thin tube into the nasal cavity to gain access to the maxillary sinus. The goal of the procedure is to improve drainage from the maxillary sinus and treat chronic maxillary sinusitis.

2. Official Description

The official description of CPT code 31256 is: ‘Nasal/sinus endoscopy, surgical, with maxillary antrostomy.’

3. Procedure

1. The provider inserts an endoscope into the nasal cavity.
2. They gain access to the maxillary sinus through a cut in the uncinate process.
3. The provider opens the maxillary sinus to improve drainage.
4. The procedure is typically performed on one side of the nasal cavity.

4. Qualifying circumstances

CPT 31256 should not be reported in conjunction with codes 31233, 31237, 31267, or 31295 when performed on the same side. This code is specifically for nasal/sinus endoscopy with maxillary antrostomy and should only be used when this specific procedure is performed.

5. When to use CPT code 31256

CPT code 31256 should be used when the provider performs a surgical procedure involving nasal/sinus endoscopy with maxillary antrostomy. It is important to note that this code represents a unilateral service, meaning it is performed on one side of the nasal cavity. If the procedure is performed bilaterally, the appropriate modifier should be appended to the code.

6. Documentation requirements

To support a claim for CPT code 31256, the provider must document the following information:

• Indication for the procedure
• Details of the surgical technique used
• Date of the procedure
• Side of the nasal cavity where the procedure was performed
• Any complications or additional procedures performed

7. Billing guidelines

When billing for CPT code 31256, ensure that the procedure meets the specific criteria outlined in the code description. It should not be reported in conjunction with certain other codes when performed on the same side. It is important to follow payer guidelines and append the appropriate modifiers if the procedure is performed bilaterally.

8. Historical information

CPT code 31256 was added to the Current Procedural Terminology system on January 1, 1990. The code description was changed on January 1, 2010 to clarify its specific components.

9. Examples

1. A provider performs nasal/sinus endoscopy with maxillary antrostomy to treat chronic maxillary sinusitis in a patient.
2. During the procedure, the provider examines the nasal cavity and opens the maxillary sinus to improve drainage in a patient with recurrent sinus infections.
3. A unilateral nasal/sinus endoscopy with maxillary antrostomy is performed to address chronic maxillary sinusitis in a patient with nasal congestion and facial pain.
4. The provider uses an endoscope to visualize the nasal cavity and performs a maxillary antrostomy to treat chronic sinusitis in a patient with persistent sinus symptoms.
5. Nasal/sinus endoscopy with maxillary antrostomy is performed to alleviate symptoms of chronic maxillary sinusitis in a patient with recurrent sinus infections.
6. A provider performs a surgical procedure involving nasal/sinus endoscopy with maxillary antrostomy to address chronic maxillary sinusitis in a patient with nasal obstruction and facial pressure.
7. The provider inserts an endoscope into the nasal cavity and performs a maxillary antrostomy to improve drainage in a patient with chronic maxillary sinusitis.
8. Nasal/sinus endoscopy with maxillary antrostomy is performed to treat chronic maxillary sinusitis in a patient with persistent sinus symptoms and facial pain.
9. A unilateral nasal/sinus endoscopy with maxillary antrostomy is performed to address chronic maxillary sinusitis in a patient with recurrent sinus infections and nasal congestion.
10. The provider uses an endoscope to visualize the nasal cavity and performs a maxillary antrostomy to treat chronic sinusitis in a patient with persistent sinus symptoms and facial pressure.