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The procedure described by CPT® Code 31255 refers to a surgical nasal and sinus endoscopy that includes a total ethmoidectomy, which encompasses both anterior and posterior aspects of the ethmoid sinuses. This procedure is typically indicated for patients suffering from various conditions such as sinusitis, nasal polyps, mucoceles, and tumors. The primary goal of the surgery is to alleviate obstructions in the sinus outflow tracts by removing inflamed tissue, thereby enhancing mucociliary clearance and improving sinus drainage. The ethmoid sinuses, situated between the eyes and the bridge of the nose, contain multiple small air cells that can become obstructed or infected. The frontal sinuses, located above the ethmoid sinuses, are also addressed during this procedure to ensure comprehensive treatment. Anesthesia is administered to ensure patient comfort, and the endoscopic approach allows for a minimally invasive examination and intervention within the nasal cavity and sinuses. The procedure involves careful dissection and removal of bony structures to access and clear the sinuses, ultimately promoting better sinus health and function.
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The procedure is performed for the following indications:
The surgical procedure begins with the application of an anesthetic, which may be delivered through ribbon gauze, neurosurgical pads, or injection to ensure patient comfort during the endoscopic examination. Following anesthesia, the endoscope is carefully inserted through the nostrils into the nasal cavity, allowing for a thorough inspection of the nasopharynx, nasal septum, turbinates, and lateral nasal wall. The middle turbinate is then medialized to facilitate access to the surgical site. An incision is made in the anterior portion of the uncinate process to expose the natural ostium of the maxillary sinus, which is crucial for proper drainage.
Next, the ethmoid bulla is identified and opened. The bony structures are meticulously removed using a microdebrider or cutting forceps, with the resection extending laterally and posteriorly to uncap the remaining anterior ethmoid cells. This debridement continues until the base of the skull is reached, marking the completion of the anterior resection. To access the posterior ethmoid sinus, the basal lamella is perforated superiorly and laterally at the junction of the vertical and horizontal segments of the middle turbinate. The lateral and superior portions of the basal lamella are then excised using a microdebrider, extending posteriorly through the cells to reach the sphenoid sinus.
Once the ethmoidectomy is completed, attention is turned to the frontal sinus. An angled scope is utilized to visualize the frontal sinus, which arises from the agger nasi. The agger nasi is resected along its anterosuperior attachment to the middle turbinate, creating a patent frontal recess. An ostium probe is employed to locate the outflow tract, and the anterior nasofrontal beak is removed, followed by the excision of the superior aspect of the nasal septum. After ensuring that there is no excessive bleeding, the surgical cavity is packed, and the endoscope is carefully removed.
Post-procedure care involves monitoring the patient for any signs of bleeding or complications. The surgical site may be packed to control bleeding and promote healing. Patients are typically advised on follow-up appointments to assess recovery and ensure that the sinuses are draining properly. Instructions regarding nasal care, including the use of saline sprays or other prescribed medications, may be provided to facilitate healing and prevent infection. Recovery time can vary based on individual circumstances, but patients are generally encouraged to avoid strenuous activities during the initial healing phase.
| Short Descr | NSL/SINS NDSC W/TOT ETHMDCT | Medium Descr | NASAL/SINUS NDSC W/TOTAL ETHOIDECTOMY | Long Descr | Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior) | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 3 - Special payment adjustment rules for multiple endoscopic 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. | Endoscopic Base Code | 31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate 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) | P8I - Endoscopy - 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). | 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) | 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. | SG | Ambulatory surgical center (asc) facility service | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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. | 74 | Discontinued out-patient hospital/ambulatory surgery center (asc) procedure after administration of anesthesia: due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc). under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of modifier 74. note: the elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. for physician reporting of a discontinued procedure, see modifier 53. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 81 | Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number. | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AG | Primary physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2018-01-01 | Changed | Long medium and short descriptions changed. AMA guideline added |
| Pre-1990 | Added | Code added. |