Summary & Overview
CPT 31294: Endoscopic Transnasal Optic Nerve Decompression
CPT code 31294 represents an endoscopic transnasal procedure to decompress the optic nerve. This surgical technique uses a nasal endoscope to access and relieve compressive pathology affecting the optic nerve and is relevant for patients with optic neuropathy from compressive lesions. Nationally, the code matters for specialty surgical billing, outpatient surgical scheduling, and insurer coverage policies for orbital and skull base procedures.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical sites of service, along with payer coverage patterns and benchmark considerations where available.
The publication provides: clinical context for the procedure, typical coding and billing considerations, common modifiers used with this service, and expected sites of care. It also outlines what is present and what is not available in the input data. Data not available in the input: associated taxonomies, specific ICD-10 diagnoses, related codes, detailed payer-specific coverage criteria, and service-line reimbursement benchmarks.
Billing Code Overview
CPT code 31294 describes a procedure in which a provider passes an endoscope into the nasal cavity to decompress the optic nerve. This procedure is an endoscopic transnasal approach intended to relieve pressure on the optic nerve, typically performed by otolaryngology or neurosurgery specialists.
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Service type: Endoscopic transnasal optic nerve decompression
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Typical site of service: Hospital outpatient department or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 56-year-old male with progressive vision loss and optic nerve compression from a benign sphenoid sinus mucocoele is scheduled for endoscopic optic nerve decompression. The patient has unilateral decreased visual acuity over several weeks, afferent pupillary defect on the affected side, and imaging (CT/MRI) demonstrating bony or soft-tissue compression of the orbital apex/optic canal. The otolaryngology and neurosurgery teams coordinate preoperative planning. In the operating room under general anesthesia, the surgeon introduces a nasal endoscope 31294 to access the sphenoid sinus and posterior ethmoid region, performs mucosal elevation and targeted bony decompression of the optic canal to relieve pressure on the optic nerve, and obtains hemostasis. Intraoperative neuromonitoring or consultation with ophthalmology may occur. Typical perioperative documentation includes indication, imaging correlation, intraoperative findings, extent of decompression, anesthesia type, estimated blood loss, complications, and postoperative visual assessment. Postoperative care occurs in a short-stay or inpatient setting depending on neurologic status, with ophthalmology follow-up for visual outcome monitoring and nasal care by ENT.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing separately for the physician's interpretation or professional portion distinct from a technical facility charge |