CPT CODES

CPT Code 31086

CPT code 31086 is used for the procedure involving the removal of the frontal sinus, aiding in standardized medical procedure documentation.

Accelerate your revenue cycle

Boost patient experience and your bottom line by automating patient cost estimates, payer underpayment detection, and contract optimization in one place.

Get a Demo

What is CPT Code 31086

CPT code 31086 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 one of the four pairs of paranasal sinuses located in the forehead region, is surgically excised. This procedure may be necessary due to chronic sinusitis, tumors, or other pathological conditions affecting the frontal sinus. The use of this code helps ensure accurate billing and documentation for healthcare providers performing this specific surgical intervention.

Does CPT 31086 Need a Modifier?

For the CPT code 31086, which pertains to the removal of the frontal sinus, the following modifiers may be applicable depending on the specific circumstances of the procedure:

1. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both sides of the body. If the removal of the frontal sinus is conducted bilaterally, this modifier should be appended to indicate that the procedure was performed on both frontal sinuses.

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 that multiple procedures were performed.

3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It may be necessary if the removal of the frontal sinus is performed in a separate session or is not typically performed together with other procedures.

4. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier is used to indicate that both surgeons are involved in the procedure.

5. Modifier 76 - Repeat Procedure by Same Physician: If the removal of the frontal sinus needs to be repeated by the same physician, this modifier is used to indicate that the procedure was repeated.

6. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician, this modifier is used to indicate that the procedure was repeated by another provider.

7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: 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: If an unrelated procedure is performed by the same physician during the postoperative period, this modifier is used to indicate that the procedure is unrelated to the original surgery.

These modifiers help provide additional information to payers about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is important to review the specific payer guidelines and documentation requirements when applying these modifiers.

CPT Code 31086 Medicare Reimbursement

The CPT code 31086 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that outlines the payment rates for services covered by Medicare, including those represented by CPT codes. To determine if CPT code 31086 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and what the associated reimbursement rate is.

Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make coverage determinations within their jurisdictions. They may have specific Local Coverage Determinations (LCDs) that affect whether CPT code 31086 is reimbursed. Providers should check with their respective MAC to understand any regional policies or requirements that might impact reimbursement for this code.

In summary, while CPT code 31086 may be reimbursed by Medicare, providers must review the MPFS and consult with their MAC to confirm coverage and reimbursement specifics.

Are You Being Underpaid for 31086 CPT Code?

Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 31086, RevFind provides unparalleled accuracy in identifying discrepancies by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and optimize your financial outcomes.

Get paid in full by bringing clarity to your revenue cycle

Full Page Background