CPT 31239 Dacryocystorhinostomy Reimbursement | OpenPayer

Summary & Overview

CPT 31239: Dacryocystorhinostomy (External)

CPT code 31239 denotes dacryocystorhinostomy (DCR), an external surgical procedure that creates a new tear drainage pathway to treat chronic tearing or recurrent lacrimal infections. Nationally, this code represents a specialized ophthalmic-otolaryngologic service that is significant for surgical case mix, utilization monitoring, and procedural authorization workflows owing to its operative setting and potential for bundled services. Key payers addressed in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise clinical context for DCR, typical sites of service, and the procedural rationale. The publication summarizes benchmarking metrics and payer coverage considerations that affect authorization and claim adjudication, highlights common modifiers used with surgical services (listed separately), and outlines coding neighbors and billing scenarios to be aware of. The content is intended for billing managers, surgical program directors, and policy analysts seeking a national-level reference for how CPT code 31239 is classified, where it is typically performed, and what operational and payer-facing issues commonly arise. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 31239dacryocystorhinostomyophthalmic surgerylacrimal systemexternal DCRambulatory surgeryoperative codingsurgical billing

Billing Code Overview

CPT code 31239 describes a dacryocystorhinostomy (DCR), a surgical procedure that reduces or eliminates excessive tearing (epiphora) or recurrent infections of the lacrimal drainage system by creating a new pathway for tear drainage. The technique involves an external incision along the side of the nose and creation of an opening through the nasal bone to connect the lacrimal sac with the nasal cavity.

Service type: Surgical ophthalmic procedure to restore lacrimal drainage
Typical site of service: Hospital operating room or ambulatory surgery center

Clinical & Coding Specifications

Clinical Context

A 62-year-old female presents with chronic epiphora (excessive tearing) and recurrent dacryocystitis of the left eye despite conservative management including topical antibiotics and lacrimal sac massage. Examination reveals persistent tearing, mucopurulent discharge, and nasolacrimal duct obstruction confirmed by syringing and dacryocystography. The surgical plan is an external dacryocystorhinostomy to create a new osteotomy from the lacrimal sac into the nasal cavity to restore tear drainage.

Preoperative workflow includes history and focused ophthalmologic and otolaryngologic evaluation, informed consent, and perioperative medical clearance. On the day of surgery the patient undergoes general anesthesia or monitored anesthesia care, a skin incision along the lateral nose is made, bone is removed to create an anastomosis between the lacrimal sac and nasal mucosa, and silicone stents may be placed. Postoperative care includes topical antibiotics, analgesia, nasal care, and follow-up visits for suture and stent management and assessment of symptom resolution or complications such as bleeding, infection, or restenosis.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When billing for the surgeon's professional component separately from facility charges in a split-billing arrangement.

CPT 31240: Endoscopic Intranasal Procedure for Concha Bullosa Removal

CPT-31295-MAXILLARY-SINUS-OSTIAL-DILATION-ENDOSCOPIC

CPT 31295: Endoscopic Maxillary Sinus Ostial Dilation

CPT-31238-ENDOSCOPIC-NASAL-HEMOSTASIS

CPT 31238: Endoscopic Nasal Hemostasis

CPT-31235-SPHENOID-SINUS-DIAGNOSTIC-ENDOSCOPY

CPT 31235: Diagnostic Endoscopy of the Sphenoid Sinus

31276-NASALSINUS-ENDOSCOPY-SURGICAL-WITH-FRONTAL-SINUS

CPT 31276: Surgical Endoscopy with Frontal Sinus Exploration

CPT-31243-POSTERIOR-NASAL-NERVE-CRYOABLATION-ENDOSCOPIC

CPT 31243: Endoscopic Cryoablation of Posterior Nasal Nerve

CPT-31254-PARTIAL-ANTERIOR-ETHMOIDECTOMY-ENDOSCOPIC-SINUS-SURGERY

CPT 31254: Partial Anterior Ethmoidectomy, Endoscopic Sinus Surgery

CPT-31241-ENDOSCOPIC-SPHENOPALATINE-ARTERY-LIGATION-NASAL

CPT 31241: Endoscopic Sphenopalatine Artery Ligation for Epistaxis

CPT-31291-ENDOSCOPIC-NASAL-REPAIR-CSF-LEAK-SPHENOID

CPT 31291: Endoscopic Nasal Repair of CSF Leak in Sphenoid Sinus

CPT-31257-ETHMOIDECTOMY-WITH-SPHENOIDOTOMY

CPT 31257: Ethmoidectomy with Sphenoidotomy

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Taxonomy Code	Specialty	Notes
207A00000X	Otolaryngology (ENT)	ENT surgeons commonly perform DCR in conjunction with nasal approach and management of intranasal anatomy.
207W00000X	Ophthalmology	Oculoplastic surgeons frequently perform DCR and manage lacrimal pathway disorders.
2080P0221X	General Surgery, Plastic Surgery sub-specialty (Oculoplastic/Facial Plastics)	Facial plastic surgeons with oculoplastic training may perform DCR in select practices.
363L00000X	Anesthesiology	Provides general anesthesia or monitored anesthesia care for the procedure.
2084P0800X	Plastic Surgery	In some settings, plastic surgeons with orbital/oculoplastic expertise perform external DCR.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H04.521`	Epiphora, right lacrimal system	Symptom indicating tear drainage obstruction prompting DCR when conservative therapy fails.
`H04.522`	Epiphora, left lacrimal system	As above, for left-sided obstruction; often used to identify laterality for procedure coding.
`H04.523`	Epiphora, bilateral lacrimal system	Bilateral tearing that may necessitate bilateral DCR.
`H04.89`	Other disorders of lacrimal system	Used for lacrimal pathology not otherwise specified that may require surgical intervention.
`H04.131`	Dacryocystitis, acute, right lacrimal sac	Acute infection of the lacrimal sac that can lead to chronic obstruction and indication for DCR.
`H04.132`	Dacryocystitis, acute, left lacrimal sac	Left-sided acute dacryocystitis potentially leading to DCR if recurrent or complicated.
`H04.133`	Dacryocystitis, chronic	Chronic infection/inflammation of the lacrimal sac commonly treated definitively with DCR.
`Q30.2`	Narrowing of nasal cavity	Anatomical nasal factors that can contribute to lacrimal drainage issues and be addressed in planning DCR.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`31231`	Nasal/sinus endoscopy, diagnostic, with or without collection of specimen(s) by brushing or washing	Performed preoperatively or intraoperatively for nasal evaluation; endoscopic assessment may be used when planning endonasal DCR approaches.
`31237`	Nasal/sinus endoscopy, surgical; with dilatation (balloon) of sinus ostium(s)	May be used in endonasal approaches or adjunctive sinonasal procedures when combined with DCR in select cases.
`66999`	Unlisted procedure, anterior segment of eye (used if specific adjuncts not listed)	Rarely used for unlisted or unusual lacrimal procedures or novel techniques related to tear drainage when no specific code exists.
`12052`	Repair partial-thickness wounds of face, ears, eyelids; 2.5 cm to 7.5 cm (example skin closure)	Represents potential closure code for the external skin incision when separate billing for complex closure is indicated.
`36415`	Collection of venous blood by venipuncture	Routine preoperative laboratory testing for anesthesia clearance and perioperative management.

Note: If a payer requires separate coding for stent insertion or nasal work specific endoscopic codes may be considered in concert with payer bundling rules.

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