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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 31293, this procedure specifically includes the surgical decompression of both the medial and inferior walls 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 procedure, 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 surgeon carefully exposes the medial orbital wall, which is the inner wall of the eye socket, and thins it using a specialized tool called a burr. This step is crucial for safely accessing the orbital contents. Elevators are then employed to open the medial orbital wall, and the lamina papyracea, a thin bony structure that separates the orbit from the sinuses, is removed to facilitate further decompression. For the inferior orbital wall, the procedure follows a similar approach, where the lamina papyracea is traced to the roof of the maxillary sinus. The floor of the orbit, or inferior orbital wall, is then thinned and opened using an elevator, allowing for effective decompression. Additionally, incisions made in the orbital periosteum, the connective tissue surrounding the bones of the orbit, enable orbital fat to prolapse, further relieving pressure on the orbital contents. It is important to note that CPT® Code 31293 is specifically designated for cases where both the medial and inferior orbital walls are decompressed, distinguishing it from CPT® Code 31292, which is used when only one of these walls is addressed.
© Copyright 2025 Coding Ahead. All rights reserved.
The surgical nasal/sinus endoscopy with orbital decompression, as described by CPT® Code 31293, is indicated for various conditions that may lead to increased pressure within the orbit or require surgical intervention to alleviate symptoms. The following are explicitly provided indications for this procedure:
The procedure for CPT® Code 31293 involves several detailed steps to ensure effective decompression of both the medial and inferior orbital walls:
After the completion of the procedure, patients are typically monitored for any immediate complications. Post-procedure care may include instructions for pain management, the use of ice packs to reduce swelling, and guidelines for activity restrictions to promote healing. Follow-up appointments are essential to assess recovery and ensure that the decompression has effectively alleviated symptoms. Patients may also be advised on signs of potential complications, such as increased pain, vision changes, or signs of infection, which should prompt immediate medical attention.
| 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 and 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. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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). | 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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| 2020-01-01 | Changed | Code description changed. |
| 2013-01-01 | Changed | Medium Descriptor changed. |
| 2011-01-01 | Changed | Short description changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |
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