CPT CODES

CPT Code 31288

CPT code 31288 is used for nasal/sinus endoscopy surgery, helping healthcare providers categorize and document medical procedures.

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 31288

CPT code 31288 is used to describe a surgical procedure involving a nasal or sinus endoscopy. This code specifically refers to the endoscopic removal of tissue or other material from the nasal or sinus cavities. It is typically utilized when a healthcare provider performs a minimally invasive procedure to address issues such as chronic sinusitis or nasal polyps. The endoscopy allows the surgeon to visualize the nasal passages and sinuses with a camera, ensuring precise removal of obstructions or diseased tissue, thereby improving the patient's breathing and sinus function.

Does CPT 31288 Need a Modifier?

For the CPT code 31288, which pertains to nasal/sinus endoscopy surgery, the following modifiers may be applicable depending on the specific circumstances of the procedure:

1. Modifier 50 - Bilateral Procedure: This modifier is used when the procedure is performed on both sides of the body. If the nasal/sinus endoscopy surgery is conducted bilaterally, this modifier should be appended to indicate that the procedure was performed on both nasal passages.

2. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same surgical session, Modifier 51 is used to indicate that more than one procedure was performed. This is relevant if the nasal/sinus endoscopy is part of a series of procedures conducted simultaneously.

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 may be necessary if the nasal/sinus endoscopy is performed in conjunction with other procedures that are not typically reported together.

4. Modifier 76 - Repeat Procedure by Same Physician: If the nasal/sinus endoscopy needs to be repeated by the same physician on the same day, Modifier 76 is used to indicate the repeat nature of the procedure.

5. Modifier 77 - Repeat Procedure by Another Physician: Similar to Modifier 76, this modifier is used when the procedure is repeated on the same day but by a different physician.

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: This modifier is applicable if the patient needs to return to the operating room for a related procedure during the postoperative period of the initial nasal/sinus endoscopy.

7. 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 nasal/sinus endoscopy, Modifier 79 should be used.

8. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. If the nasal/sinus endoscopy involves significantly more effort or complexity, Modifier 22 may be appropriate.

Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association and payer policies to ensure accurate billing and reimbursement.

CPT Code 31288 Medicare Reimbursement

CPT code 31288, which involves nasal/sinus endoscopy surgery, is subject to reimbursement by Medicare, but several factors determine its eligibility and the reimbursement amount. The Medicare Physician Fee Schedule (MPFS) is a crucial resource that outlines the payment rates for services covered under Medicare Part B, including surgical procedures like those associated with CPT code 31288. Healthcare providers should consult the MPFS to verify the specific reimbursement rate for this code, as it can vary based on geographic location and other factors.

Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide guidance on local coverage determinations (LCDs) that may affect the reimbursement of CPT code 31288. Providers should ensure that they meet any specific documentation or medical necessity requirements outlined by their respective MAC to facilitate successful reimbursement. It is advisable for healthcare providers to regularly review updates from both the MPFS and their MAC to stay informed about any changes that could impact the reimbursement of CPT code 31288.

Are You Being Underpaid for 31288 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 31288, 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 safeguard your practice's financial health.

Get paid in full by bringing clarity to your revenue cycle

Full Page Background