tci Outpatient Facility Coding Alert - 2019 Issue 6

Reader Question: Bank on This Criteria for 31267 Reporting

Question: I’m coding a maxillary antrostomy. The doctor documents a small amount of tissue removed from the maxillary sinus. Can I bill as 31267? Virginia Subscriber Answer: An operative report is necessary in order to reach a definitive answer. You will need to provide further documentation of what constitutes a “small amount of tissue” in order to decide between codes 31267 (Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus) and 31256 (Nasal/sinus endoscopy, surgical, with maxillary antrostomy). In order to report code 31267, the surgeon must remove tissue from within the maxillary...

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