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2025 CPT code 31259

Endoscopic surgical excision of ethmoid and sphenoid sinuses

Code 31259 includes dilation of the sinus ostia and diagnostic endoscopy. Fluoroscopy, if used, is included. This code is unilateral unless otherwise specified. Modifier -50 should be used for bilateral procedures.

Modifiers may be applicable, for example, 50 for bilateral procedures, 22 for increased procedural services or 52 for reduced services.

Medical necessity for this procedure is established by documentation demonstrating chronic sinusitis involving the ethmoid and sphenoid sinuses with persistent symptoms despite appropriate medical therapy.

In simple words: The surgeon uses a small camera and instruments inserted through the nose to remove infected tissue and widen the openings of the ethmoid and sphenoid sinuses in the skull. This helps to improve drainage and relieve sinus pressure.

This procedure involves a complete excision of the ethmoid air cells (anterior and posterior) and widening of the sphenoid sinus opening using a nasal/sinus endoscope. It is typically performed to address chronic sinusitis.

Example 1: A patient with chronic ethmoid and sphenoid sinusitis unresponsive to medical management undergoes endoscopic sinus surgery with excision of the ethmoid air cells and widening of the sphenoid sinus ostium. , A patient with recurrent sinus infections localized to the ethmoid and sphenoid sinuses requires surgical intervention. The surgeon performs an endoscopic ethmoidectomy and sphenoidotomy to remove diseased tissue and improve sinus drainage., A patient has a nasal polyp originating in the ethmoid sinus extending into the sphenoid sinus. Endoscopic surgery is performed to remove the polyp and address the underlying sinus disease in both the ethmoid and sphenoid sinuses.

Documentation should include the diagnosis of chronic sinusitis affecting the ethmoid and sphenoid sinuses, failed medical management, operative report detailing the surgical approach, tissues removed, and any complications encountered.

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