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Endoscopic Medial Maxillectomy

Denise Posted Fri 05th of July, 2019 12:45:49 PM
I have an insurance company what feels that an endoscopic medial maxillectomy should be compared to 31267. The surgeon is removing the maxilla not tissue from the maxillary sinus. CPT assistant states to bill with 31299. What would you recommend that we should be billing and what comparative code would you recommend?
SuperCoder Answered Mon 08th of July, 2019 04:51:21 AM

Hi Denise,

 

There is no appropriate CPT code for Endoscopic Maxillectomy. We should use an unlisted CPT code 31299 for the procedure. I would suggest you use CPT code 31225 as a comparison code for the performed procedure. CPT code 31225 is for maxillectomy performed through open intraoral approach and would be the appropriate comparison CPT code. 

 

When submitting an unlisted-procedure code, your documentation should also include an explanatory cover letter. An insurer will decide to pay an unlisted-procedure claim by comparing your procedure description to a similar, listed procedure with an established reimbursement value.  

 

Thanks!

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