Summary & Overview
CPT 31086: Osteoplastic Frontal Sinus Excision with Bone Flap
CPT code 31086 represents an open frontal sinus procedure involving a brow incision, osteoplastic flap of the frontal bone, excision of diseased frontal sinus tissue (such as benign neoplasm or polyp), and repositioning of the bone flap. This operative code is relevant nationally for otolaryngology and craniofacial surgical practices managing complex frontal sinus disease and surgical resections.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, expected service settings, and payer coverage scope. The publication also summarizes typical benchmarks and payment considerations, outlines commonly reported modifiers, and highlights policy updates and coding guidance that affect claim adjudication for this type of frontal sinus surgery.
The content is intended for billing and coding professionals, practice administrators, and clinicians involved in procedural documentation. It provides clear clinical description, payer coverage landscape, and the operational context needed to support accurate coding and claims submission for CPT code 31086 at a national level.
Billing Code Overview
CPT code 31086 describes a surgical procedure in which a provider makes a brow incision to access the frontal sinus, resects an osteoplastic flap of the frontal bone of the forehead, excises diseased frontal sinus tissue (for example, a benign neoplasm or polyp), and repositions the frontal bone flap with sutures.
-
Service type: Open frontal sinus surgery with osteoplastic flap and excision of diseased tissue
-
Typical site of service: Inpatient or outpatient surgical setting, commonly performed in an operating room
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45–65 year-old adult presenting with chronic frontal sinus disease refractory to endoscopic management, recurrent frontal sinus mucocele, or a benign frontal sinus neoplasm (eg, inverted papilloma) causing symptoms of forehead pain, recurrent infection, drainage, or cosmetic deformity. Workup includes history, sinonasal endoscopy, CT scan of the sinuses showing frontal sinus opacification, bony erosion, or mass, and preoperative counseling regarding risks (bleeding, CSF leak, scarring, altered forehead sensation). The procedure is performed in an operating room under general anesthesia. The surgeon makes a brow incision, elevates an osteoplastic frontal bone flap, excises diseased frontal sinus mucosa or tumor, irrigates and inspects the sinus, and repositions and secures the bone flap with sutures or plates. Postoperative course includes short inpatient observation or same-day discharge depending on intraoperative complexity and patient comorbidities, pain control, sinus precautions, and outpatient follow-up with imaging or endoscopic surveillance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the procedure required substantially greater work than typical (eg, extensive bone work, prolonged dissection). |
23 |