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A surgical nasal/sinus endoscopy with optic nerve decompression is a specialized procedure that involves the use of an endoscope to visualize and treat conditions affecting the nasal cavity and paranasal sinuses. This procedure is particularly focused on relieving pressure on the optic nerve, which can be caused by various abnormalities or diseases within the sinus structures. During the procedure, a topical nasal decongestant is applied to reduce swelling and facilitate easier access to the nasal passages. Additionally, a local anesthetic with a vasoconstrictor may be used to minimize discomfort and control bleeding. The endoscope, a thin, flexible tube equipped with a camera and light source, is inserted through the nostrils to allow the surgeon to inspect the nasal cavity and the surrounding sinuses for any signs of disease or structural issues. The procedure includes the meticulous clearing of the anterior and posterior ethmoid cells, which are small air-filled spaces located between the nose and the eyes. Following this, the anterior wall of the sphenoid sinus is surgically removed to expose the bony channel that houses the optic nerve. This step is critical as it allows the surgeon to access the optic nerve channel directly. The decompression of the optic nerve is achieved by using a burr, which is a surgical instrument that grinds away bone in a controlled manner, moving from the back (posterior) to the front (anterior) of the sinus. This technique is essential for alleviating any pressure that may be exerted on the optic nerve by bony fragments or blood clots. By removing these obstructions, the procedure aims to restore normal function and alleviate symptoms associated with optic nerve compression, thereby improving the patient's overall visual health.
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The surgical nasal/sinus endoscopy with optic nerve decompression is indicated for specific conditions that may lead to optic nerve compression or related symptoms. These indications include:
The procedure for nasal/sinus endoscopy with optic nerve decompression involves several critical steps, each designed to ensure effective treatment and patient safety. The steps include:
After the completion of the nasal/sinus endoscopy with optic nerve decompression, patients may require specific post-procedure care to ensure proper recovery. This may include monitoring for any signs of complications, such as bleeding or infection. Patients are typically advised to avoid strenuous activities and to follow up with their healthcare provider for further evaluation and management. Pain management may be necessary, and patients may be prescribed medications to help with discomfort. Additionally, instructions regarding nasal care and any necessary follow-up imaging or assessments will be provided to ensure optimal healing and recovery.
| Short Descr | NSL/SINS NDSC SURG ON DCMPRN | Medium Descr | NASAL/SINUS NDSC SURG W/OPTIC NERVE DCMPRN | Long Descr | Nasal/sinus endoscopy, surgical, with optic nerve decompression | 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). | 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. |
| 2011-01-01 | Changed | Short description changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |
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