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Nasal/sinus endoscopy, surgical, with dilation (CPT® Code 31296) refers to a minimally invasive procedure aimed at treating chronic sinusitis characterized by obstruction of the frontal sinus ostium, which is the opening that allows drainage from the frontal sinus into the nasal cavity. This procedure involves the use of an endoscope, a thin, flexible tube equipped with a camera and light, which is inserted through the nostrils to visualize the nasal passages and sinuses. The primary goal of the endoscopic dilation is to restore normal sinus drainage by widening the obstructed ostium. This is achieved through the inflation of a small balloon that compresses the surrounding mucosa and displaces any bony structures that may be contributing to the blockage. Prior to the procedure, a topical nasal decongestant and local anesthetic with a vasoconstrictor may be applied to minimize discomfort and reduce bleeding. The procedure is particularly beneficial for patients suffering from chronic sinusitis who have not responded to medical management, as it can significantly improve sinus drainage and alleviate symptoms associated with sinus obstruction.
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The procedure is indicated for patients suffering from chronic sinusitis with obstruction of the frontal sinus ostium. This condition may present with symptoms such as persistent nasal congestion, facial pain or pressure, reduced sense of smell, and recurrent sinus infections. The surgical intervention aims to alleviate these symptoms by restoring normal drainage from the frontal sinus.
The procedure begins with the application of a topical nasal decongestant and local anesthetic with a vasoconstrictor to minimize discomfort and control bleeding during the endoscopic intervention. Following this, an endoscope is carefully introduced through the nostrils and advanced to the affected paranasal sinus, specifically targeting the frontal sinus ostium. In cases where dilation of the maxillary sinus is required, the procedure may involve puncturing the canine fossa using a trocar, which is a sharp instrument designed to create an opening. The canine fossa is located at the front of the maxilla, just below the infraorbital opening and adjacent to the canine tooth socket. Once the endoscope is in place, a guidewire catheter equipped with a small balloon is introduced and navigated into the ostium of the obstructed sinus. The balloon is then inflated to compress the surrounding mucosa and displace any obstructive bony structures, effectively widening the ostium. After inflation, the balloon is deflated, and the ostium is inspected through the endoscope to assess the adequacy of dilation. This inflation and deflation process is repeated as necessary until the ostium is sufficiently dilated to restore normal sinus drainage. Upon completion of the dilation, the endoscope is carefully removed from the nasal cavity.
After the procedure, patients may experience some nasal congestion and minor discomfort, which can typically be managed with over-the-counter pain relief medications. It is important for patients to follow any specific post-operative care instructions provided by their healthcare provider, which may include recommendations for nasal saline irrigation to promote healing and maintain sinus drainage. Patients should also be monitored for any signs of complications, such as excessive bleeding or infection, and should report any concerning symptoms to their healthcare provider promptly. The expected recovery time can vary, but many patients may return to normal activities within a few days, depending on individual circumstances and the extent of the procedure performed.
| Short Descr | NSL/SINS NDSC SURG FRNT SINS | Medium Descr | NASAL/SINUS NDSC SURG W/DILATION FRONTAL SINUS | Long Descr | Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal sinus ostium | 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) | 2 - Payment restriction for assistants at surgery does not apply 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 | Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs. | 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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. | GA | Waiver of liability statement issued as required by payer policy, individual case | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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. | 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. | 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.) | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CR | Catastrophe/disaster related | 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 | 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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| 2020-01-01 | Changed | Code description changed. |
| 2018-01-01 | Changed | AMA guideline changed. |
| 2011-01-01 | Added | Added |
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