Were cutting tools used to remove tissue? That's the key question to ask when coding balloon sinuplasty procedures. If the surgeon used cutting tools along with a balloon to create a sinusotomy, then you can report sinus endoscopy CPT codes 31256 (nasal/sinus endoscopy with maxillary antrostomy), 31276 (nasal/ sinus endoscopy with front sinus exploration) or 31287 (nasal/sinus endoscopy with sphenoidectomy) for the excisional component of the procedure.

If your surgeon expanded the patient's passageway with a balloon but didn't use cutting tools to remove tissue, report balloon sinuplasty alone as CPT code 31299 (Unlisted procedure, accessory sinuses).

The balloon dilation usually is considered inclusive, but some payors may consider the balloon dilation to be a method of antrostomy/sinusotomy rather than a distinct procedure, and require the procedure to be coded to the appropriate sinusotomy code (31256, 31276 or 31287). Check your payor's coverage instructions before submitting codes.

The American Academy of Otolaryngology-Head and Neck Surgery has endorsed codes 31256, 31276 and 31287 to describe sinus balloon catheterization when these conditions are met:

• a sinus endoscope is used to position the balloon before and during the cannulation of the ostia, and to confirm the dilatation with the balloon; and
• when bone and mucosa are moved in such a fashion to significantly enlarge the ostia of the sinus addressed.

For payors that recognize HCPCS Level II temporary national codes, you can report S2344 (Nasal/sinus endoscopy, surgical; with enlargement of sinus ostium opening using inflatable device [balloon sinuplasty]). This procedure isn't specific to a sinus and can be used for either the maxillary, frontal or sphenoid sinuses. Unfortunately, not all payors allow or recognize the use of the HCPCS Level II temporary national codes and, as with the unlisted CPT code 31299, most payors don't reimburse the procedure as they consider it investigational.