© Copyright 2025 American Medical Association. All rights reserved.
The procedure described by CPT® Code 31257 involves a nasal and sinus endoscopy that is surgical in nature, specifically focusing on a total ethmoidectomy, which includes both anterior and posterior ethmoid cells, as well as a sphenoidotomy. This procedure is primarily indicated for the treatment of various conditions affecting the sinuses, such as sinusitis, nasal polyps, mucoceles, and tumors. The goal of the surgery is to alleviate obstruction in the sinus outflow tracts by removing inflamed tissue, thereby enhancing mucociliary clearance, which is essential for proper sinus function. The ethmoid sinuses, situated between the eyes and the bridge of the nose, typically contain multiple small air cells that can become obstructed or infected. The sphenoid sinus, located at the back of the nasal cavity, is positioned superior to the nasopharynx and anterior to the sella turcica, making it a critical area for drainage and ventilation. During the procedure, an anesthetic is applied to ensure patient comfort, and a specialized endoscope is utilized to visualize and access the nasal cavity and sinuses. The surgical steps involve careful inspection and manipulation of the nasal structures, including the middle turbinate and uncinate process, to facilitate access to the ethmoid and sphenoid sinuses. This comprehensive approach allows for the effective removal of obstructive tissue and restoration of normal sinus drainage pathways.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 31257 is indicated for the following conditions:
The surgical procedure begins with the application of an anesthetic, which may be delivered through ribbon gauze, neurosurgical pads, or via injection to ensure patient comfort during the operation. Following anesthesia, the endoscope is carefully inserted through the nostril into the nasal cavity. The surgeon inspects the nasal cavity, nasopharynx, nasal septum, turbinates, and lateral nasal wall for any abnormalities. To gain access to the maxillary sinus, the middle turbinate is medialized, and an incision is made in the anterior portion of the uncinate process, exposing the natural ostium of the maxillary sinus. The ethmoid bulla is then identified and opened, allowing for the removal of the bony portion using a microdebrider or cutting forceps. This resection is performed laterally and continued posteriorly to uncap the remaining anterior ethmoid cells, which are subsequently debrided to the base of the skull. The anterior resection is considered complete once the lamella of the middle turbinate is reached. To access the posterior ethmoid sinus, the surgeon perforates the basal lamella 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 removed using a microdebrider, extending posteriorly through the cells to reach the face of the sphenoid sinus. The sphenoidotomy is performed by either enlarging the natural sphenoid ostium with a punch or other instruments or by creating a new opening through a thin section of bone on the anterior face of the sphenoid sinus using a blunt knife or curette. Following the sphenoidotomy, the surgeon may remove sphenoid tissue from the sinus using a curette or microdebrider. After the surgical steps are completed, the cavity is thoroughly checked for any bleeding, packed as necessary, 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 patients are typically advised on how to manage any discomfort or pain following the procedure. Recovery may vary depending on the individual and the extent of the surgery performed. Patients are often instructed to avoid strenuous activities and to follow up with their healthcare provider for further evaluation and management of their sinus health. Proper post-operative care is essential to ensure healing and to minimize the risk of complications.
| Short Descr | NSL/SINS NDSC TOT W/SPHENDT | Medium Descr | NASAL/SINUS NDSC TOTAL WITH SPHENOIDOTOMY | Long Descr | Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy | 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 | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
| 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). | 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). | 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) | GC | This service has been performed in part by a resident under the direction of a teaching physician | SG | Ambulatory surgical center (asc) facility service | 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. | 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). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) 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. | 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. | 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. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | 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 | Added | Code Added. |