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A surgical nasal/sinus endoscopy is a minimally invasive procedure that involves the use of an endoscope to visualize and treat conditions affecting the nasal cavity and paranasal sinuses. In the context of CPT® Code 31292, this procedure specifically includes the surgical decompression of either the medial or inferior wall of the orbit, which is the bony structure surrounding the eye. The procedure begins with the application of a topical nasal decongestant and a local anesthetic, often combined with a vasoconstrictor to minimize bleeding and enhance visibility during the surgery. An endoscope, a thin, flexible tube equipped with a camera and light source, is then inserted through the nostrils to allow the surgeon to inspect the nasal passages and sinuses for any signs of disease or abnormalities. During the endoscopy, the ethmoidal air cells, which are small cavities located between the nose and the eyes, are cleared to improve drainage and reduce the risk of infection. The surgical approach involves exposing and thinning the medial orbital wall using a specialized tool known as a burr. Once adequately thinned, elevators are employed to carefully open the medial orbital wall, allowing for the removal of the lamina papyracea, a thin bony structure that separates the orbit from the sinuses. If the inferior orbital wall requires decompression, the procedure follows a similar technique, where the lamina papyracea is traced to the roof of the maxillary sinus, and the floor of the orbit is thinned and opened using an elevator. To facilitate further decompression of the orbital contents, incisions are made in the orbital periosteum, which allows orbital fat to prolapse into the surgical area. This additional step is crucial for alleviating pressure within the orbit, thereby providing relief from symptoms associated with conditions such as orbital edema or increased intraorbital pressure. CPT® Code 31292 is specifically designated for cases where only the medial or inferior orbital wall is decompressed, while CPT® Code 31293 is applicable when both walls are addressed during the procedure.
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The surgical nasal/sinus endoscopy with orbital decompression, as described by CPT® Code 31292, is indicated for various conditions that may lead to increased pressure within the orbit or other related complications. The following are explicitly provided indications for this procedure:
The procedure for nasal/sinus endoscopy with orbital decompression involves several critical steps, each designed to ensure effective treatment while minimizing complications. The following procedural steps are outlined:
After the completion of the nasal/sinus endoscopy with orbital decompression, patients are typically monitored for any immediate complications. Post-procedure care may include instructions for pain management, the use of nasal saline sprays to keep the nasal passages moist, and guidelines for activity restrictions to promote healing. Patients may also be advised to avoid strenuous activities and to follow up with their healthcare provider to assess recovery and ensure that the desired outcomes of the procedure are achieved. Any signs of infection or unusual symptoms should be reported promptly to the healthcare provider for further evaluation.
| Short Descr | NSL/SINS NDSC MED/INF DCMPRN | Medium Descr | NASAL/SINUS NDSC SURG MEDIAL/INF ORB WALL DCMPRN | Long Descr | Nasal/sinus endoscopy, surgical, with orbital decompression; medial or inferior wall | Status Code | Active Code | Global Days | 010 - 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) | 0 - 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 | 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 |
| 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. | 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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) | 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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| 2020-01-01 | Changed | Code description changed. |
| 2011-01-01 | Changed | Short description changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |
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