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Sinus Surgery

Sharon Posted Sun 20th of November, 2011 18:24:53 PM

Please help with CPT codes for this sinus surgery.
1. Unilateral endoscopic sinus surgery with anterior ethmoidectomies and maxillary antrostomies including intranasal removal of extensive polyp disease.
2. Bilateral turbinoplasty.
DESCRIPTION OF PROCEDURE: The patient is brought to the operating suite where she is induced under satisfactory general endotracheal anesthesia by the oral route. She is then positioned for nasal exposure and, after topical application of Afrin and injection of 1% Xylocaine with epinephrine, she is prepped and draped in a sterile standard fashion. The polyps are notable and manipulation of the polyp allows further injections. The polyp is first removed with forceps for biopsy and then a microdebrider used to perform most of the polypectomy. The polyp has extensively expanded the size of the maxillary antrum but the uncinate process is taken down with a backbiting forceps after prolapsing.

Visible after removal of the polyp disease is the frontal recess which is not involved on CT scan. Likewise, polyps are removed from the maxillary sinus itself with a combination of 30-degree scope as well as a microdebrider. Maxillary sinus is irrigated. Anterior and posterior ethmoidectomy completed with no evidence of any significant exudates. No involvement of the sphenoid sinus.

Next, a turbinoplasty is undertaken. First, the right then the left turbinates are treated, first with infracturing, submucosal radiofrequency ablation, then lateralizing of these turbinates.

SuperCoder Answered Mon 21st of November, 2011 07:11:44 AM

Hi, belows are the codes for this OP note:

For anterior ethmoidectomies---31254
For maxillary sinus antrostomies with intranasal removal of extensive poly p disease-- 31267
For bilateral turbinoplasty --30140-50

So final codes should be:

Remember: You will wonder when you look code desc. 31267 in the CPT manual that says with removal of tissue from maxillay sinus, but when you really read CPT manual under code 31240: It clearly mentions use code 31254 with 31267 with or without removal of polyp.
For bilateral turbinoplasty, code is 30140 and you could use LT, RT or both codes with second line -50, 2 units etc. as per your payer's policy.

If the physian's would have fully cuts through the turbinate bones, mucosa and all, you would have use 30130 (Excision inferior turbinate, partial or complete, any method) instead of 30140.
Hope this helps

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