The new year has brought a host of new CPT codes for nearly every area of the body, and sinuses are no different. These codes, which fall into the broader category of functional endoscopic sinus surgery (FESS), include changes for bundles involving ethmoidectomies, frontal sinusotomies, and sphenoidotomies. Because of the closely related nature of these different procedures, it is critical to study them closely to ensure you know exactly which code you need for a situation.

The new FESS codes for 2018 are as follows:

31253: Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed

31257: Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy

31259: Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus

It is worth noting, however, that these new codes do not cover every procedure involving sinuses. For example, maxillary antrostomies cannot be bundled in with these codes, which means that they must be coded separately (e.g., a maxillary antrostomy that is performed along with a total ethmoidectomy and a frontal sinusotomy of the same side would have to be coded with both CPT codes 31253 and either 31256 or 31257 depending on whether or not any tissue was removed).

One major issue that was not addressed in this update was how to code an operation of all four sinuses on one side. Though there are a few different combinations of codes that can cover this procedure at present, the American Medical Association (AMA) is expected to release more specific instructions and guidance in the next edition of CPT Assistant, due out in the near future. In the meantime, coders should use their best judgement and stay tuned for the coming updates.