How To Use CPT Code 31257

CPT 31257 describes a surgical procedure involving the excision of the ethmoid air cells and the widening of the sphenoid sinus cavity. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 31257?

CPT 31257 involves a surgical procedure that includes the complete removal of the ethmoid air cells, both anterior and posterior, as well as the enlargement of the opening of the sphenoid sinus cavity. This procedure is typically performed to treat chronic sinusitis.

2. Official Description

The official description of CPT code 31257 is: ‘Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy.’

3. Procedure

1. The provider begins by preparing the patient and administering anesthesia.
2. A rigid or flexible endoscope is inserted into the nasal cavity to gain access to the anterior portion.
3. The provider resects the uncinate process, which is a hooklike extension of the ethmoid bone, and widens the maxillary antrum.
4. The ethmoid bulla, a rounded projection off the ethmoid bone, is identified, opened, and resected to provide a clear view of the nasal lamellae and retrobulbar space.
5. The provider then opens and removes the anterior ethmoid air cells using forceps and a shaver.
6. The posterior ethmoid is opened, and the bony partition is removed to visualize the ethmoid roof and create a relatively smooth cavity.
7. The provider identifies and protects the posterior artery from injury.
8. The diseased and loose bony partition from the lamella papyracea is removed.
9. The opening of the sphenoid sinus cavity is enlarged using cutting forceps.
10. The provider carefully avoids a cerebrospinal fluid (CSF) leak and retrobulbar herniation throughout the procedure.
11. Finally, the forceps and scope are removed from the nasal cavity, and the nasal cavity is packed with epinephrine-soaked cotton balls.

4. Qualifying circumstances

CPT 31257 is performed on patients with chronic sinusitis who require the complete removal of the ethmoid air cells and the widening of the sphenoid sinus cavity. It is important to note that CPT code 31257 should not be reported in conjunction with other specific codes related to nasal/sinus endoscopy procedures on the same side.

5. When to use CPT code 31257

CPT code 31257 should be used when a provider performs a surgical procedure involving the complete removal of the ethmoid air cells (both anterior and posterior) and the widening of the sphenoid sinus cavity. It is important to ensure that the procedure is not performed on the same side as other specific nasal/sinus endoscopy procedures.

6. Documentation requirements

To support a claim for CPT code 31257, the provider must document the following information:

• Patient’s diagnosis of chronic sinusitis
• Details of the procedure performed, including the excision of the ethmoid air cells and the widening of the sphenoid sinus cavity
• Date of the procedure
• Any complications or specific circumstances encountered during the procedure
• Signature of the performing provider

7. Billing guidelines

When billing for CPT code 31257, it is important to ensure that the procedure is not reported in conjunction with other specific nasal/sinus endoscopy codes performed on the same side. Additionally, it is crucial to follow the appropriate guidelines for reporting and coding this procedure accurately.

8. Historical information

CPT code 31257 was added to the Current Procedural Terminology system on January 1, 2018. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with chronic sinusitis undergoes a surgical procedure involving the complete removal of the ethmoid air cells and the widening of the sphenoid sinus cavity.
2. A provider performs CPT code 31257 on a patient with chronic sinusitis to alleviate symptoms and improve sinus function.
3. During the procedure, the provider carefully avoids complications such as cerebrospinal fluid leaks and retrobulbar herniation.
4. CPT code 31257 is utilized by a surgeon to treat a patient with chronic sinusitis who has not responded to conservative treatment measures.
5. A patient with chronic sinusitis undergoes a successful surgical procedure involving the complete removal of the ethmoid air cells and the widening of the sphenoid sinus cavity, resulting in improved sinus drainage.
6. The provider performs CPT code 31257 on a patient with chronic sinusitis to address recurrent infections and improve overall sinus health.
7. During the procedure, the provider takes necessary precautions to protect the posterior artery and avoid complications.
8. CPT code 31257 is reported by a surgeon who performs a successful ethmoidectomy and sphenoidotomy on a patient with chronic sinusitis, providing long-term relief.
9. A patient with chronic sinusitis undergoes a comprehensive surgical procedure involving the complete removal of the ethmoid air cells and the widening of the sphenoid sinus cavity, resulting in improved sinus ventilation.
10. The provider utilizes CPT code 31257 to document a surgical intervention performed on a patient with chronic sinusitis, aiming to alleviate symptoms and improve quality of life.