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Official Description

Sinusotomy, sphenoid, with or without biopsy; with mucosal stripping or removal of polyp(s)

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 31051 refers to a sinusotomy of the sphenoid sinus, which is a surgical intervention performed to access the sphenoid sinus located at the center of the skull base. This sinus is the most posterior of the paranasal sinuses and can be approached through various surgical techniques. The common language description outlines three primary approaches for evaluating lesions or masses within the sphenoid sinus: the transpalatal approach, the transnasal transseptal approach, and the external transorbital transethmoidal approach. Each of these methods involves specific incisions and manipulations to gain access to the sinus. In the transpalatal approach, an incision is made in the palate, allowing for the elevation of a palatal flap, which exposes the nasopharynx and the floor of the sphenoid sinus. This is followed by the removal of portions of the hard palate and vomer using a drill or rongeur to open the sphenoid sinus. The transnasal transseptal approach involves accessing the sphenoid sinus through the nostril, with potential augmentation through a sublabial incision. This method requires severing attachments to the anterior sphenoid wall to enter the sinus using fine rongeurs or a sphenoid punch. The external transorbital transethmoidal approach necessitates an external incision through the orbit and an ethmoidectomy to facilitate access to the sphenoid sinus. The procedure may include mucosal stripping or the removal of polyps, with or without obtaining a biopsy. Mucosal stripping involves the elevation and removal of the sinus mucosa, while polypectomy entails grasping and completely removing any polyps present within the sinus. This surgical intervention is critical for addressing various conditions affecting the sphenoid sinus, ensuring that any obstructive or pathological tissues are effectively managed.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The indications for performing a sphenoid sinusotomy, as described by CPT® Code 31051, include the following conditions:

  • Evaluation of Lesions or Masses - This procedure is indicated for the assessment of abnormal growths or lesions within the sphenoid sinus that may require further investigation or intervention.
  • Chronic Sinusitis - Patients suffering from chronic sinusitis that does not respond to medical management may require surgical intervention to alleviate symptoms and improve sinus drainage.
  • Polyps - The presence of polyps within the sphenoid sinus can obstruct normal sinus function, necessitating their removal to restore proper drainage and function.
  • Biopsy of Suspicious Tissue - If there are concerns regarding the nature of tissue within the sphenoid sinus, a biopsy may be performed to obtain a sample for pathological examination.

2. Procedure

The procedure for a sphenoid sinusotomy, as outlined in CPT® Code 31051, involves several key steps that ensure effective access and treatment of the sphenoid sinus. Each approach has its specific procedural details:

  • Transpalatal Approach - This approach begins with an incision made in the palate, allowing the surgeon to elevate a palatal flap. The soft palate musculature is then separated from the hard palate, exposing the nasopharynx and the floor of the sphenoid sinus. A drill or rongeur is utilized to remove portions of the hard palate and vomer, thereby creating an opening into the sphenoid sinus for further evaluation or treatment.
  • Transnasal Transseptal Approach - In this method, access is gained through the nostril, with the option of augmenting exposure via a sublabial incision. The superior turbinate is exposed, and attachments to the anterior sphenoid wall are severed. Fine rongeurs or a sphenoid punch are then employed to enter the sphenoid sinus, allowing for direct access to the area of concern.
  • External Transorbital Transethmoidal Approach - This approach requires an external incision through the orbit, followed by an ethmoidectomy to facilitate access to the sphenoid sinus. This method is typically reserved for more complex cases where other approaches may not provide adequate access.
  • Mucosal Stripping or Polypectomy - Once access to the sphenoid sinus is achieved, the procedure may involve mucosal stripping, where the sinus mucosa is elevated and removed, or a polypectomy, where polyps are grasped with forceps and removed in their entirety. If a biopsy is indicated, biopsy forceps are passed into the sinus to obtain a tissue sample for further analysis.

3. Post-Procedure

Post-procedure care following a sphenoid sinusotomy includes monitoring for any complications such as bleeding or infection. Patients may experience some discomfort and swelling in the nasal and facial areas, which can be managed with appropriate pain relief measures. It is essential to provide instructions for nasal care, including saline irrigation to keep the nasal passages moist and promote healing. Follow-up appointments are typically scheduled to assess recovery and ensure that the sinus is healing properly. Any signs of persistent symptoms or complications should be reported to the healthcare provider promptly for further evaluation and management.

Short Descr SPHENOID SINUS SURGERY
Medium Descr SINUSOT SPHENOID W/MUCOSAL STRIPPING/RMVL POLYP
Long Descr Sinusotomy, sphenoid, with or without biopsy; with mucosal stripping or removal of polyp(s)
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P1G - Major procedure - Other
MUE 1
CCS Clinical Classification 33 - Other OR therapeutic procedures on nose, mouth and pharynx
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
GC This service has been performed in part by a resident under the direction of a teaching physician
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
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