CPT CODES

CPT Code 31087

CPT code 31087 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 31087

CPT code 31087 is a medical billing code used to describe the surgical procedure for the removal of the frontal sinus. This procedure typically involves accessing the frontal sinus, which is located in the forehead region, to remove tissue or other material that may be causing blockages or infections. The removal of the frontal sinus is often necessary to alleviate chronic sinusitis or other sinus-related issues that have not responded to less invasive treatments. This code is used by healthcare providers to accurately document and bill for the procedure in the healthcare revenue cycle.

Does CPT 31087 Need a Modifier?

For CPT code 31087, which involves 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 body. In the context of sinus surgery, if the removal is performed on both frontal sinuses, this modifier would be appropriate.

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 indicates 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 through a different approach than other procedures.

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

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 the repeat nature of the procedure.

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

7. Modifier 78 - Unplanned Return to the Operating Room: If the patient needs to return to the operating room for a related procedure during the postoperative period, this modifier is used to indicate the unplanned nature of the return.

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 of the initial surgery, this modifier is used to indicate the unrelated nature of the new procedure.

These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.

CPT Code 31087 Medicare Reimbursement

The CPT code 31087, which involves the removal of the frontal sinus, is subject to reimbursement by Medicare, but this is contingent upon several factors. Primarily, the Medicare Physician Fee Schedule (MPFS) plays a crucial role in determining whether a specific CPT code is reimbursable. The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals, and it is updated annually to reflect changes in policy and practice.

For CPT code 31087, you would need to verify its inclusion and the associated reimbursement rate within the MPFS. Additionally, Medicare Administrative Contractors (MACs) are responsible for processing claims and have the authority to make determinations on coverage and reimbursement for specific services in their respective jurisdictions. Therefore, it is essential to consult the local MAC for any specific coverage policies or additional documentation requirements that may affect the reimbursement of CPT code 31087.

In summary, while CPT code 31087 can be reimbursed by Medicare, it is important to confirm its status on the MPFS and adhere to any guidelines or requirements set forth by the relevant MAC to ensure successful reimbursement.

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