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.
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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.
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Service type: Surgical ophthalmic procedure to restore lacrimal drainage
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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. |
50 | Bilateral procedure | When a DCR is performed on both the left and right lacrimal systems during the same operative session. |
22 | Increased procedural services | When work, time, or complexity substantially exceeds typical DCR and documentation supports higher-than-usual work. |
52 | Reduced services | When a DCR is partially performed or aborted and less than the full procedure is completed. |
53 | Discontinued procedure | When the DCR is started but terminated before completion for patient-related or intraoperative reasons. |
59 | Distinct procedural service | When an identifiable DCR is separate from another service on the same day and not normally bundled. |
76 | Repeat procedure by same physician | When the same surgeon repeats the DCR same-day for a related problem. |
79 | Unrelated procedure by same physician (Note: not in supplied list) | Data not available in the input. |
78 | Unplanned return to OR for a related procedure during postoperative period | When a patient returns to the operating room for an unplanned revision related to the initial DCR. |
80 | Assistant surgeon required | When a surgical assistant (e.g., another physician) participates and billing requires identification of an assistant surgeon. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services following supervision rules | When an APP provides substantive portion of the service per payer policy. |
LT | Left side | When the procedure is performed on the left lacrimal system. |
RT | Right side | When the procedure is performed on the right lacrimal system. |
GK | Not in supplied list | Data not available in the input. |
| 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.