Coding Clarification: Reporting Code 31237 for Endoscopic Sinus Debridement

 CPT Assistant, July 2021, Volume 31, Issue 7, page 3

Endoscopic debridements following routine endoscopic sinus surgery (ESS) may be performed to improve long-term outcomes, as debridement of necrotic material can facilitate healing. While limited use of debridements will suffice in most cases, there are clinical scenarios in which no debridement may be needed. There are also scenarios in which a patient may require more frequent or long-term debridements. This may include, but is not limited to, those patients with persistent and infected crusting with necrotic tissue or biofilms at the surgical site, adhesion formation compromising healing and/or visualization, underlying immunologic or mucociliary disorders associated with delayed healing, and retained foreign material that may be interfering with wound healing. The frequency and length of time for which debridement is medically necessary will vary from case to case and must be individualized and documented. This article will clarify the appropriate reporting of code 31237 when debridement is performed.

Endoscopy

 

 

31237 

Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure) 

Code 31237 is used to report postoperative debridement, as well as polypectomy and/or biopsy, which may be required for treatment of nasal polyps unresponsive to medical management or for suspected neoplasm.

The generally accepted definition of surgical debridement involves the removal of necrotic or infected soft tissue and bone (including biofilms) or retained foreign material to facilitate wound healing. There are references to various descriptions of debridement in the Current Procedural Terminology (CPT®) code set. For example, the descriptor of code 97597, Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less, in the Active Wound Care Management subsection of the Medicine section notes various methods of debridement, including sharp selective debridement with scissors, scalpel, and forceps.

Although there is no definition for intranasal sinus debridement in the CPT code set, the clinical concepts are parallel to debridement as used in other sections of the CPT code set and in surgical practice generally. Code 31237 includes endoscopic use of cutting and grasping instruments for the removal of necrotic, diseased tissue that is interfering with wound healing in a postoperative patient. Code 31237 may not be reported for endoscopically examining the operative site and suctioning blood, clots, and/or inspissated mucus alone. Assuming all other code criteria are satisfied, simple suctioning of such material would be inherent to code 31231, Nasal endoscopy, diagnostic, unilateral or bilateral.

ESS procedures are predominantly assigned 0-day global periods, but several procedures have assigned 10-day global periods. Endoscopic debridements of the operative sites performed beyond the code-specific global period are reported with code 31237 and, if bilateral, with modifier 50, Bilateral Procedure, appended. Sinus debridements within the global period of another intranasal procedure that generally does not require debridement, such as septoplasty, may be reported by appending modifier 79, Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period, to code 31237.

Documentation associated with the use of code 31237 should include the medical necessity for performing debridement, specific site(s) addressed, type of anesthesia, depth of material debrided with instruments and endoscopes utilized, manner of hemostasis, and use of and/or the type of packing. As with all procedures, complications and any other relevant factors should be included.

The article "Coding Consultation" in the December 2001 issue of CPT® Assistant, as well as the article "Coding Clarification: Post-Endoscopic Sinus Surgery Debridements" in the December 2011 issue have also addressed this topic.