CPT CODES

CPT Code 31267

CPT code 31267 is a procedure for endoscopic surgery to remove tissue from the maxillary sinus, often used to treat sinus issues.

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What is CPT Code 31267

CPT code 31267 is used to describe a surgical procedure involving an endoscopic approach to the maxillary sinus. Specifically, this code refers to an endoscopic sinus surgery where the maxillary sinus is accessed and tissue is removed. This procedure is typically performed to treat chronic sinusitis or other sinus-related issues by clearing blockages, removing polyps, or addressing infections. The use of an endoscope allows for a minimally invasive approach, which can lead to quicker recovery times and less postoperative discomfort for the patient.

Does CPT 31267 Need a Modifier?

For CPT code 31267, which pertains to an endoscopic procedure involving the maxillary sinus, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and their reasons for use:

1. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both the left and right maxillary sinuses during the same session.

2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.

3. Modifier 59 - Distinct Procedural Service: Utilized to indicate that the procedure is distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.

4. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician on the same day.

5. Modifier 77 - Repeat Procedure by Another Physician: Applied when the procedure is repeated by a different physician on the same day.

6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used if the patient returns to the operating room for a related procedure during the postoperative period.

7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when the procedure is unrelated to the original procedure and occurs during the postoperative period.

8. Modifier 22 - Increased Procedural Services: Applied when the work required to perform the procedure is substantially greater than typically required.

9. Modifier 23 - Unusual Anesthesia: Used when a procedure that usually requires either no anesthesia or local anesthesia must be performed under general anesthesia due to unusual circumstances.

10. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: Used when an evaluation and management service is performed during the postoperative period for a reason unrelated to the original procedure.

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 vary.

CPT Code 31267 Medicare Reimbursement

CPT code 31267 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the policies of the local Medicare Administrative Contractor (MAC).

The MPFS provides a comprehensive listing of fees used to reimburse physicians and other healthcare providers for services covered by Medicare. However, the actual reimbursement for CPT code 31267 can vary based on geographic location, as each MAC has the authority to interpret national Medicare policies and establish local coverage determinations (LCDs) that may affect payment.

Therefore, it is essential for healthcare providers to verify the specific reimbursement details for CPT code 31267 with their respective MAC to ensure compliance and accurate billing.

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