Summary & Overview
CPT 31287: Endoscopic Creation of Sphenoid Sinus Opening
CPT code 31287 represents an endoscopic nasal procedure to create an opening in the sphenoid sinus. This procedure is part of functional endoscopic sinus surgery (FESS) and is performed to improve sinus drainage, relieve obstructive disease, and access the sphenoid sinus for diagnostic or therapeutic interventions. Nationally, use of targeted endoscopic sinus procedures has clinical importance for patients with chronic rhinosinusitis, sphenoid sinusitis, or other sinonasal disease impacting the sphenoid recess.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for CPT code 31287, typical sites of service, and an outline of common billing modifiers and considerations. The publication also summarizes expected benchmarks and policy-relevant points related to coverage and claim processing where available. The material is intended to inform billing staff, clinical coders, and policy analysts on the code’s clinical purpose, payer coverage landscape, and areas to review for accurate coding and submission.
Data not available in the input is noted where specific payer policies, related ICD-10 pairings, and detailed utilization benchmarks are not provided.
Billing Code Overview
CPT code 31287 describes an endoscopic nasal procedure in which the provider inserts an endoscope into the nasal cavity and creates an opening in the sphenoid sinus. This procedure is an endoscopic sinus surgery focused on accessing and draining or ventilating the sphenoid sinus.
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Service type: Endoscopic sinus surgical procedure
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Typical site of service: Operative suite or ambulatory surgical center (inpatient or outpatient settings depending on clinical context)
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient presents to an otolaryngology clinic with chronic sphenoid sinusitis characterized by deep-seated retro-orbital pressure, recurrent headaches, and purulent nasal drainage despite multiple courses of antibiotics and topical nasal steroid therapy. Nasal endoscopy in clinic demonstrates purulence and inflammation in the sphenoethmoidal recess. CT imaging of the paranasal sinuses confirms opacification and ostial obstruction of the sphenoid sinus. The patient is scheduled for an endoscopic transnasal sphenoidotomy (31287) under general anesthesia in an ambulatory surgical center. The clinical workflow includes preoperative evaluation and consent, intraoperative endoscopic access via the nasal cavity with identification of anatomic landmarks (sphenoid ostium, skull base, optic canal), creation of a sphenoidotomy to establish drainage and ventilation, hemostasis, and possible limited debridement of diseased mucosa. Postoperative care includes recovery monitoring, nasal saline irrigations, topical steroids, short antibiotic course if indicated, and follow-up nasal endoscopy to assess healing and patency of the sphenoid ostium.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the physician interpretation or professional portion if technical component billed separately |