Is sinus surgery medically necessary?

Is sinus surgery medically necessary?

Is sinus surgery medically necessary?

Medical Necessity. Aetna considers endoscopic sinus surgery (ESS) medically necessary for any of the following indications: Allergic fungal rhino-sinusitis with objective evidence of disease by computerized tomographic (CT) imaging (see CT imaging requirements below)*; or. Antrochoanal polyp documented by CT imaging*; …

What are two types of nasal endoscopy procedures included in code range 31231 31298?

Within the endoscopic sinus surgery codes, there are two separate procedure designated codes: 31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure) and 31237 Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure).

Is 31267 a bilateral procedure?

Bilateral Surgery (50) CCS Clinical Classification. Co-Surgeons (62) Diagnostic Imaging Family.

What is the code for a nasal endoscopy?

CPT 31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure), is the base code for this family of endoscopic surgeries.

Does 31237 need a modifier?

31237 – nasal/sinus endoscopy, surgical with biopsy, polypectomy, or debridement (separate procedure). Use modifier 52 to indicate the decreased level of service provided as a Post Op FESS procedure (31237-52 LT, or 31237-52 RT or to indicate bilateral procedure 31237-52-50).

What is the CPT code for endoscopic sinus surgery?

Endoscopic Sinus Surgery Codes
CPT Code Description
31276 Nasal/sinus endoscopy, surgical; with frontal sinus exploration, with or without removal of tissue from frontal sinus
31287 Nasal/sinus endoscopy, surgical; with sphenoidotomy

How is endoscopic sinus surgery performed?

The sinus surgeon will use an endoscope — a thin camera rod with a light at the end — to magnify and better see the sinus tissues. Specialized instruments open the sinuses widely by safely and effectively removing causes of sinus blockage like mucous membrane swelling, nasal polyps and scar tissue.

When is sinus surgery indicated?

You may require sinus surgery if: You have chronic sinusitis that isn’t responding to treatment. You have severe sinus polyps. There is an abnormality within the structure of the nose or sinus that requires repair (e.g. deviated septum)

What is the CPT code 31298?

31298. Nasal/sinus endoscopy, surgical; with dilation of frontal and. sphenoid sinus ostia (eg, balloon dilation) 5155.