Summary & Overview
CPT 31000: Maxillary Sinus Washout / Irrigation
CPT code 31000 denotes insertion of a flexible cannula into the maxillary sinus for irrigation and washout of sinus contents. The code captures a specific surgical procedure used to evacuate purulent material, mucus, or debris from the maxillary sinus when conservative care is insufficient or direct sinus drainage is clinically indicated. Nationally, this procedural code matters for otolaryngology service classification, facility billing, and case-mix accounting in ambulatory surgical and hospital outpatient environments.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when the procedure is performed, typical sites of service, and what the CPT descriptor encompasses. The publication outlines benchmarks and billing considerations relevant to payers listed above, summarizes common modifier usage found in administrative practice (input provided), and flags where additional coding detail or diagnosis linkage is often required.
The report is intended to help coding managers, revenue cycle staff, and clinical leaders understand the role of CPT code 31000 within surgical ENT services, typical billing settings, and the administrative elements that commonly accompany claims for maxillary sinus irrigation.
Billing Code Overview
CPT code 31000 describes insertion of a flexible cannula into the maxillary sinus through an incision in the antrum or via a natural ostium to irrigate and wash out the sinus contents. This procedure is a form of maxillary sinus lavage intended to clear infectious material, debris, or accumulated secretions.
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Service type: Surgical sinus irrigation / maxillary sinus washout
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Typical site of service: Operative suite, ambulatory surgical center, or hospital outpatient setting depending on clinical need and anesthesia requirements.
Clinical & Coding Specifications
Clinical Context
A 42-year-old patient presents to the otolaryngology clinic with acute unilateral facial pain, purulent nasal drainage, nasal congestion, and fever after several weeks of persistent maxillary sinus disease despite oral antibiotics and intranasal steroids. Otolaryngology documents refractory acute bacterial maxillary sinusitis with clinical and endoscopic findings of purulence in the middle meatus and opacification of the maxillary sinus on CT imaging. The provider decides to perform maxillary sinus irrigation using a flexible cannula inserted through the canine fossa antrum puncture or via the natural ostium to wash out infected material and relieve symptoms.
The clinical workflow includes pre-procedure evaluation and informed consent, topical and/or local anesthesia with or without sedation, preparation of the nasal cavity, cannulation of the maxillary sinus through the antrum or natural opening, irrigation and suction removal of contents, assessment of sinus patency, hemostasis, and post-procedure instructions. The procedure may occur in an ambulatory surgery center, hospital outpatient department, emergency department, or office procedure room depending on patient status and anesthesia needs.
Coding Specifications
- The following modifiers are most clinically relevant for this procedure. Each modifier code is CMS-standardized; descriptions explain typical application.
| Modifier | Description | When to Use |
|---|---|---|
26 |