How To Use CPT Code 31295

CPT 31295 describes a surgical procedure involving nasal/sinus endoscopy with dilation of the maxillary sinus ostium. 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 31295?

CPT 31295 is a code used to describe a surgical procedure that involves the use of an endoscope to examine the nasal cavity and the dilation of the maxillary sinus ostium. This procedure can be performed either transnasally or via the canine fossa, a depression on the outer surface of the jaw bone.

2. Official Description

The official description of CPT code 31295 is: ‘Nasal/sinus endoscopy, surgical, with dilation of maxillary sinus ostium (e.g., balloon dilation), transnasal or via canine fossa.’

3. Procedure

1. The provider begins by applying a topical nasal decongestant to the patient, who is appropriately prepped and anesthetized.
2. Access to the sinus is gained either through the nose or through an incision in the upper gums.
3. A balloon catheter is introduced into the orifice in the maxilla or the opening to the maxillary sinus through the nose or upper jaw.
4. The provider confirms the position of the balloon and the wire using an endoscope.
5. The balloon is then inflated to dilate the sinus ostium.
6. At the end of the procedure, the balloon is deflated and removed.

4. Qualifying circumstances

CPT 31295 is typically performed on patients who require dilation of the maxillary sinus ostium. It is important to note that this code should not be reported in conjunction with codes 31233, 31256, or 31267 when performed on the same side.

5. When to use CPT code 31295

CPT code 31295 should be used when a provider performs nasal/sinus endoscopy with dilation of the maxillary sinus ostium. It is important to ensure that the procedure is performed transnasally or via the canine fossa. This code should not be used in conjunction with certain other codes when performed on the same side.

6. Documentation requirements

To support a claim for CPT 31295, the provider must document the following information:

• Confirmation of the need for dilation of the maxillary sinus ostium
• Details of the procedure, including the approach used (transnasal or via canine fossa)
• Date of the procedure
• Any additional relevant information or findings

7. Billing guidelines

When billing for CPT 31295, it is important to ensure that the procedure is performed as described in the official description. This code should not be reported in conjunction with certain other codes when performed on the same side. Modifier 50 should be appended for bilateral procedures, or modifiers LT and RT should be appended for procedures performed on the left and right sides, respectively.

8. Historical information

CPT 31295 was added to the Current Procedural Terminology system on January 1, 2011. The code was later updated on January 1, 2020, with a revised description.

9. Examples

1. A provider performs nasal/sinus endoscopy with dilation of the maxillary sinus ostium via the canine fossa to relieve a patient’s chronic sinusitis.
2. Using a transnasal approach, a provider performs nasal/sinus endoscopy with dilation of the maxillary sinus ostium to treat a patient’s recurrent sinus infections.
3. A patient undergoes nasal/sinus endoscopy with dilation of the maxillary sinus ostium via the canine fossa to alleviate symptoms of nasal congestion and facial pain.
4. A provider performs nasal/sinus endoscopy with dilation of the maxillary sinus ostium transnasally to address a patient’s chronic sinus blockage.
5. Using a canine fossa approach, a provider performs nasal/sinus endoscopy with dilation of the maxillary sinus ostium to treat a patient’s sinus polyps.
6. A patient undergoes nasal/sinus endoscopy with dilation of the maxillary sinus ostium via the canine fossa to alleviate symptoms of chronic sinusitis and improve sinus drainage.
7. A provider performs nasal/sinus endoscopy with dilation of the maxillary sinus ostium transnasally to address a patient’s recurrent sinus infections and improve sinus ventilation.
8. Using a canine fossa approach, a provider performs nasal/sinus endoscopy with dilation of the maxillary sinus ostium to treat a patient’s chronic sinus blockage and improve sinus drainage.
9. A patient undergoes nasal/sinus endoscopy with dilation of the maxillary sinus ostium via the canine fossa to alleviate symptoms of nasal congestion, facial pain, and pressure.
10. A provider performs nasal/sinus endoscopy with dilation of the maxillary sinus ostium transnasally to address a patient’s sinus polyps and improve sinus ventilation.