Summary & Overview
CPT 31085: Frontal Sinus Obliteration with Osteoplastic Flap
CPT code 31085 represents an osteoplastic frontal sinus obliteration performed through a coronal incision with resection and replacement of a frontal bone flap. This invasive craniofacial surgical procedure permanently obliterates the frontal sinus and is significant nationally for management of refractory frontal sinus disease, trauma, chronic infection, or neoplasm where sinus function preservation is not feasible. The procedure has implications for surgical resource use, inpatient versus outpatient placement, and postoperative care planning.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis covers common payer approaches to coverage and authorization, relative utilization benchmarks, and clinical context relevant to coding and billing decisions.
Readers will find a concise clinical overview of the procedure, typical sites of service, and the clinical situations that prompt use of this code. The publication provides benchmarking context for utilization and payment patterns, summarizes notable policy considerations that affect coverage and prior authorization, and outlines coding nuances to assist billing and revenue cycle teams. Data not available in the input is identified where necessary.
Billing Code Overview
CPT code 31085 describes an open frontal sinus obliteration procedure. The provider makes a coronal incision, advances into the frontal sinus, and creates an osteoplastic flap of the forehead's frontal bone. The frontal sinus is then packed with material to obliterate and render it nonfunctional, and the frontal bone flap is repositioned and secured with sutures.
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Service type: Surgical craniofacial procedure for frontal sinus obliteration
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Typical site of service: Hospital operating room or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with chronic frontal sinus disease (recurrent frontal sinusitis, mucocele, chronic osteomyelitis of the frontal sinus, or failed endoscopic sinus surgery) who presents with persistent pain, recurrent infections, drainage, or radiographic evidence of destructive disease of the frontal sinus. After failure of maximal medical therapy and endoscopic approaches, the otolaryngologist or facial plastic surgeon schedules an open frontal sinus obliteration via osteoplastic flap.
Preoperative workflow includes history and physical, CT scan of the sinuses with coronal views, possible MRI if intracranial extension is suspected, preoperative anesthesia evaluation, and informed consent discussing risks of forehead incision, forehead bone flap, and sinus obliteration. In the operating room under general anesthesia, a coronal or eyebrow incision is made, a frontal bone osteoplastic flap is elevated, diseased mucosa is removed, the sinus cavity is packed/obliterated with autologous fat, bone, or alloplastic material, and the bone flap is repositioned and secured with sutures or plates. Postoperative care includes wound care, antibiotics as indicated, pain control, and follow-up imaging if complication or persistent disease is suspected. Typical sites of service are inpatient hospital operating room or ambulatory surgery center when appropriate for patient comorbidity and procedure complexity.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |