By Samuel T. Harris, March 10, 2026

Facial Plastic Surgery Institute Website

Transformative Changes in Nasal Endoscopy Coding and Billing

Each year, as January 1 approaches, new, revised, and deleted billing codes come into play. This evolving coding landscape necessitates that outsourcing companies, which provide billing and medical coding services, rigorously analyze updates. They focus on ensuring that physician practices adapt their resources and protocols accordingly, facilitating accurate claims submission. In 2020, practices in the field of otolaryngology faced significant alterations regarding endoscopic sinus billing and coding, including updates to Current Procedural Terminology (CPT) codes and the introduction of specialized rules pertaining to multiple endoscopic procedures.

Understanding Nasal Endoscopy

Nasal endoscopy represents a pivotal procedure routinely executed in otolaryngologists’ offices. During this minimally invasive technique, a physician utilizes an endoscope—a slender, flexible tube equipped with a magnified video camera and light—to examine both the nasal and sinus passages. This innovation allows for the projection of enlarged images onto a monitor, providing invaluable insights during consultations.

Physicians commonly employ nasal endoscopy for various health concerns, including:

Nasal congestion
Nasal blockage
Infections affecting the nasal and sinus areas (rhinosinusitis)
Nasal polyps
Nasal tumors
Recurring nosebleeds
A diminished sense of smell
Cerebrospinal fluid leaks

This procedure allows healthcare professionals to ascertain intricacies regarding conditions such as tissue swelling, bleeding, or tumors that visual examination alone might not reveal. Furthermore, it facilitates the removal of foreign objects from the nasal cavity and monitors the effectiveness of treatments aimed at alleviating nasal and sinus issues.

When blockages occur, sinus surgery may be recommended to excise obstructions, reestablish natural drainage pathways, and maintain sinus health. Endoscopic sinus surgery is particularly relevant for patients suffering from chronic sinusitis or other analogous conditions, such as nasal tumors and polyps. In select situations, small instruments may also be utilized to extract tissue samples or conduct other procedures.

Nasal Endoscopy Coding and Billing Modifications

The year 2020 ushered in critical changes to the coding system surrounding nasal and sinus endoscopy. These modifications included new, revised, and deleted CPT codes, alongside specific guidelines that apply to multiple endoscopic procedures.

Revised CPT Code Descriptors: The descriptors of numerous nasal/sinus endoscopy codes have been overhauled for greater specificity. For instance, the following codes have clearer distinctions:

31292 – Endoscopy, surgical, with orbital decompression, medial or inferior wall.
31293 – Endoscopy, surgical, with orbital decompression, medial and inferior wall.
31295 – Endoscopy, surgical, with dilation of the maxillary sinus ostium transnasally or via canine fossa.
31296 – Endoscopy, surgical, with dilation of the frontal sinus ostium.
31297 – Endoscopy, surgical, with dilation of the sphenoid sinus ostium.
31298 – Endoscopy, surgical, with dilation of both frontal and sphenoid sinus ostia.
A new Category III code, 0583T, was introduced for tympanostomy requiring the insertion of a ventilating tube using an automated delivery system.

Special Rules for Multiple Endoscopic Procedures: The Centers for Medicare & Medicaid Services (CMS) established a special rule applicable to multiple endoscopic processes represented by the nasal sinus medical codes 31231-31298.

Key Points of Attention

The essential points to note about the new rules are:

CPT 31231: This code represents diagnostic nasal endoscopy (unilateral or bilateral) as a separate procedure and is essential to the broader family of endoscopic surgeries. It is bundled and cannot be reimbursed separately when performed alongside other endoscopic services.
Modifier 59 or XS may be applied with 31231 in accordance with multiple endoscopy regulations, but only if distinct sites or structures are treated.
For the absence of code 31231, multiple sinus endoscopies within the same family can be reported independently.
The introduction of new codes in 2018 reiterates the need for caution in coding. These codes describe services often required together; providers must beware of unbundling them to maximize reimbursement.

Under this multiple scope rule, otolaryngologists can anticipate receiving 100% reimbursement for the most valuable procedure performed. The remaining nasal endoscopy codes will be compensated at their inherent value minus the base code’s worth (31231).

Billing for Bilateral Procedures

In response to queries raised by practitioners, CMS clarified that when multiple nasal endoscopy procedures are executed bilaterally, the reimbursement amount will be multiplied by 150%. Subsequently, the fee for the base nasal procedure, 31231, is deducted.

The Importance of Documentation

Accurate documentation is pivotal in circumventing claim denials. A study examining Medicare Part B claims for diagnostic nasal endoscopy, submitted between April and June of 2014, indicated that insufficient documentation was the predominant contributor to improper payments. To mitigate risks of denial, healthcare providers must comply with documentation stipulations set forth by Medicare administrative contractors.

Crucial elements that demand explicit documentation in the medical record include:

The precise date of service
The rationale behind the procedure
The outcomes resulting from the procedure
The signature of the physician or qualified healthcare professional (and/or a signature log or attestation)

With meticulous clinical documentation, medical billing and coding firms can accurately connect the services rendered to the appropriate nasal endoscopy billing codes, enabling appropriate reimbursements.

Conclusion

As we navigate the complexities of billing and coding for nasal procedures, such as nasal endoscopy, it is crucial to remain informed about the latest changes in the coding landscape. Ensuring compliance with the revised codes and rules will empower physicians to optimize their billing processes and uphold the integrity of their practice.

For more detailed insights into the implications of ongoing changes, please refer to our extensive coverage on the Facial Plastic Surgery Institute Website.

Disclaimer: The information presented in this article is intended for general informational purposes only and does not constitute medical advice or a substitute for professional care. For specific inquiries and clinical concerns, consult a qualified healthcare provider.