CPT CODES

CPT Code 31085

CPT code 31085 is used for the procedure involving the removal of the frontal sinus, aiding in standardized medical procedure documentation.

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What is CPT Code 31085

CPT code 31085 is used to describe the surgical procedure for the removal of the frontal sinus. This code is specifically assigned to operations where the frontal sinus, which is located in the forehead region, is excised or surgically removed. This procedure may be necessary due to chronic sinusitis, tumors, or other medical conditions affecting the frontal sinus. The use of this code helps in accurately documenting and billing for the surgical service provided by healthcare professionals.

Does CPT 31085 Need a Modifier?

For CPT code 31085, which pertains to the removal of the frontal sinus, the following modifiers may be applicable:

1. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both sides of the frontal sinus. It indicates that the procedure was performed bilaterally.

2. Modifier 51 - Multiple Procedures: If the removal of the frontal sinus is performed in conjunction with other procedures during the same surgical session, this modifier is used to indicate multiple procedures.

3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the removal of the frontal sinus is a distinct procedure from other services performed on the same day. It is used when procedures are not normally reported together but are appropriate under the circumstances.

4. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that each surgeon is performing a distinct part of the procedure.

5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the removal of the frontal sinus needs to be repeated by the same physician within a short period.

6. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician, this modifier is used to indicate the repeat nature of the procedure.

7. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is used if the patient needs to return to the operating room for a related procedure during the postoperative period.

8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if the removal of the frontal sinus is performed during the postoperative period of another procedure but is unrelated to the initial surgery.

Each of these modifiers serves a specific purpose and should be used according to the circumstances of the procedure to ensure accurate billing and reimbursement.

CPT Code 31085 Medicare Reimbursement

The CPT code 31085 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set by the Medicare Administrative Contractor (MAC) in your region.

The MPFS provides a comprehensive list of services covered by Medicare, along with the associated reimbursement rates. However, coverage can vary based on local policies established by the MAC, which administers Medicare claims and determines coverage specifics in different geographic areas.

Therefore, to determine if CPT code 31085 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year and verify any additional local coverage determinations or guidelines issued by their respective MAC.

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