How To Use CPT Code 31259

CPT 31259 describes a surgical procedure involving the removal of tissue from the sphenoid sinus, as well as the total ethmoidectomy (anterior and posterior), including sphenoidotomy. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 31259?

CPT 31259 is a code used to describe a surgical procedure that involves the complete removal of tissue from the sphenoid sinus, as well as the total ethmoidectomy (anterior and posterior), including sphenoidotomy. This procedure is typically performed to treat chronic sinusitis.

2. Official Description

The official description of CPT code 31259 is: ‘Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus.’

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 provide visualization.
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 create a relatively smooth cavity and allow visualization of the ethmoid roof.
7. The provider identifies and protects the posterior artery from injury.
8. Diseased and loose bony partitions from the lamella papyracea are removed.
9. The opening of the sphenoid sinus cavity is enlarged using cutting forceps, and any diseased tissue is removed.
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 31259 is typically performed on patients with chronic sinusitis who require the complete removal of tissue from the sphenoid sinus, as well as the total ethmoidectomy (anterior and posterior), including sphenoidotomy. It is important to note that CPT 31259 should not be reported in conjunction with other specific codes listed in the notes section of the code description.

5. When to use CPT code 31259

CPT code 31259 should be used when a provider performs a surgical procedure involving the removal of tissue from the sphenoid sinus, as well as the total ethmoidectomy (anterior and posterior), including sphenoidotomy. This code should be used specifically for cases of chronic sinusitis that require these specific surgical interventions.

6. Documentation requirements

To support a claim for CPT code 31259, the provider must document the following information:

• Patient’s diagnosis of chronic sinusitis
• Specific details of the procedure performed, including the removal of tissue from the sphenoid sinus and the total ethmoidectomy (anterior and posterior), including sphenoidotomy
• Date of the procedure
• Start and end time of the procedure
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 31259, it is important to ensure that the procedure performed matches the description of the code. Additionally, be aware of the notes section of the code description, which specifies that certain other codes should not be reported in conjunction with CPT 31259. Follow the appropriate coding guidelines and modifiers when necessary.

8. Historical information

CPT code 31259 was added to the Current Procedural Terminology system on January 1, 2018. There have been no updates to the code since its addition.

9. Examples

1. A patient with chronic sinusitis undergoes a surgical procedure involving the removal of tissue from the sphenoid sinus, as well as the total ethmoidectomy (anterior and posterior), including sphenoidotomy.
2. A provider performs a surgical procedure on a patient with chronic sinusitis, which includes the removal of tissue from the sphenoid sinus and the total ethmoidectomy (anterior and posterior), including sphenoidotomy.
3. During a surgical procedure, a provider removes tissue from the sphenoid sinus and performs a total ethmoidectomy (anterior and posterior), including sphenoidotomy, on a patient with chronic sinusitis.
4. A patient with chronic sinusitis undergoes a surgical procedure that involves the removal of tissue from the sphenoid sinus, as well as the total ethmoidectomy (anterior and posterior), including sphenoidotomy.
5. A provider performs a surgical procedure on a patient with chronic sinusitis, which includes the removal of tissue from the sphenoid sinus and the total ethmoidectomy (anterior and posterior), including sphenoidotomy.
6. During a surgical procedure, a provider removes tissue from the sphenoid sinus and performs a total ethmoidectomy (anterior and posterior), including sphenoidotomy, on a patient with chronic sinusitis.