Summary & Overview
CPT 31235: Diagnostic Endoscopy of the Sphenoid Sinus
CPT code 31235 represents a diagnostic endoscopic evaluation of the sphenoid sinus, performed either via puncture or through the natural ostium. This code captures a targeted sinonasal diagnostic procedure used to directly visualize the sphenoid sinus for assessment or sampling. Nationally, it is relevant for otolaryngology practice patterns, facility coding for ambulatory and hospital outpatient settings, and payer coverage determinations tied to sinus disease management.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical intent and settings for the procedure, typical coding considerations, and what to expect in payer coverage reviews. The publication outlines benchmarks and utilization context, highlights common modifier usage provided in the input, and summarizes implications for facility and professional billing workflows.
The content is organized to clarify clinical context, typical sites of service, and the role of this diagnostic endoscopy in evaluating sphenoid sinus disease. Data not available in the input is noted where applicable. The piece is intended for coding professionals, health plan reviewers, and clinicians who need a succinct reference to CPT code 31235 in national billing and coverage conversations.
Billing Code Overview
CPT code 31235 describes a diagnostic endoscopy of the sphenoid sinus, performed either through a direct puncture of the sinus or via the sinus's natural ostium. The procedure is intended to visualize the sphenoid sinus cavity for diagnostic purposes, which may include inspection, sampling, or assessment of sinus pathology.
Service type: Diagnostic endoscopy (sphenoid sinus)
Typical site of service: Hospital outpatient department or ambulatory surgical center, and may also be performed in specialized clinic procedure rooms equipped for endoscopic sinus procedures when appropriate equipment and clinical support are available.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an otolaryngology clinic or an ambulatory surgery center with recurrent or persistent sphenoid sinus symptoms such as deep-seated retro-orbital pressure, persistent post-nasal drip, or refractory sinusitis despite medical therapy. After clinical evaluation and CT imaging suggest isolated sphenoid sinus disease (mucous retention cyst, focal opacification, or suspected fungal infection), the provider schedules a diagnostic sphenoid endoscopy to directly visualize the sphenoid sinus ostium. The procedure is performed under local anesthesia with sedation or general anesthesia depending on patient tolerance and comorbidities. Endoscopic access is obtained through the nasal cavity via the natural ostium or via a puncture approach to sample sinus contents, inspect mucosa, and obtain cultures or tissue biopsy. Typical workflow includes preoperative consent, image review, intraoperative endoscopic inspection with targeted sampling, hemostasis, and brief recovery. This procedure is commonly performed in the ambulatory surgical center or hospital outpatient department when diagnostic sampling or direct visualization of the sphenoid sinus is required.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When work or time is substantially greater than typical for the procedure due to extensive scarring or anatomic complexity |