CPT CODES

CPT Code 31255

CPT code 31255 is used for nasal/sinus endoscopy with total ethmoidectomy, a procedure involving the removal of sinus tissue.

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What is CPT Code 31255

CPT code 31255 is a medical billing code used to describe a nasal/sinus endoscopy procedure with a total ethmoidectomy. This procedure involves the use of an endoscope, a specialized instrument with a camera, to visualize the nasal passages and sinuses. During this procedure, the surgeon removes the ethmoid sinuses, which are located between the nose and the eyes, to treat conditions such as chronic sinusitis or nasal polyps. This code is used by healthcare providers to document and bill for the surgical service provided to the patient.

Does CPT 31255 Need a Modifier?

For CPT code 31255, which involves nasal/sinus endoscopy with total ethmoidectomy, 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. It indicates that the procedure was performed bilaterally during the same operative session.

2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier is used to indicate that more than one procedure was carried out.

3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent 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 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is applicable if the procedure is performed during the postoperative period of another procedure but is unrelated to the original procedure.

5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by the same provider on the same day.

6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by a different provider on the same day.

These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements, as these can influence the use of modifiers.

CPT Code 31255 Medicare Reimbursement

The CPT code 31255 is reimbursed by Medicare, but its reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding payment rates.

However, the actual reimbursement for CPT code 31255 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for interpreting national Medicare policies and setting local coverage determinations, which can influence whether and how much Medicare reimburses for this specific code.

Therefore, healthcare providers should consult their respective MAC for precise reimbursement details related to CPT code 31255.

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