Respiratory System - Notes

Respiratory System - Nose

  • 30000: Incision and drainage of nasal abscess or hematoma using an intranasal approach. (For external approach, see 10060, 10140)
  • 30020: Incision and drainage of abscess or hematoma of the nasal septum.

Respiratory System - Excision

  • 30100: Biopsy of the nose.
    • (For biopsy of the skin of the nose, see 11102, 11103, 11104, 11105, 11106, 11107)
  • 30110: Excision of nasal polyp(s), using a simple approach.
    • Typically completed in an office setting.
    • To report a bilateral procedure, use 30110 with modifier 50.
  • 30115: Excision of nasal polyp(s), using an extensive approach.
    • Typically requires the facilities available in a hospital setting.
    • To report a bilateral procedure, use 30115 with modifier 50.
  • 30117: Excision or destruction (e.g., laser) of an intranasal lesion via an intranasal approach.
    • CPT Assistant References: Jul 19, Nov 19, Sep 20, Jan 22, Feb 23, Dec 23
  • 30118: Excision or destruction (e.g., laser) of an intranasal lesion using a lateral rhinotomy approach.
    • CPT Changes: An Insider's View 2002
    • CPT Assistant: Dec 23

Endoscopic Procedures

  • 31242: Surgical nasal/sinus endoscopy with destruction by radiofrequency ablation of the posterior nasal nerve.
  • 31243: Surgical nasal/sinus endoscopy with destruction by cryoablation of the posterior nasal nerve.

Rhinophyma

  • 30120: Excision or surgical planing of the skin of the nose for rhinophyma.
    • CPT Assistant: May

Nasal Cysts and Tumors

  • 30124: Excision of a dermoid cyst of the nose, simple, skin, subcutaneous.
  • 30125: Excision of a dermoid cyst of the nose, complex, under bone or cartilage.

Turbinate Procedures

  • 30130: Excision of the inferior turbinate, partial or complete, any method.
    • CPT Changes: An Insider's View 2000
    • CPT Assistant: Feb, Nov, Sep, May
    • For excision of the superior or middle turbinate, use 30999.
  • 30140: Submucous resection of the inferior turbinate, partial or complete, any method.
    • CPT Changes: An Insider's View
    • CPT Assistant: Nov 98:11, Dec 02:10, Apr 03:28, May 03:5,
    • Do not report 30130 or 30140 in conjunction with 30802, 30930.
    • For submucous resection of the superior or middle turbinate, use 30999.
    • For endoscopic resection of concha bullosa of the middle turbinate, use 31240.
    • For submucous resection of the nasal septum, use 30520.

Partial or Total Rhinectomies

  • 30150: Rhinectomy, partial.
  • 30160: Rhinectomies, total.
    • For closure and/or reconstruction, primary or delayed, see Integumentary System codes 13151-13160, 14060-14302, 15120, 15121, 15260, 15261, 15760, 20900-20912.

Nasal Introductions and Displacements

  • 30200: Injection into turbinate(s), therapeutic.
    • CPT Assistant:IIa
  • 30210: Displacement therapy (Proetz type).
  • 30220: Insertion, nasal septal prosthesis (button).

Foreign Body Removal

  • 30300: Removal of a foreign body from the nose, intranasal, office-type procedure.
    • CPT Assistant: Jan 12:13
  • 30310: Removal of a foreign body from the nose requiring general anesthesia.
  • 30320: Removal of a foreign body from the nose by lateral rhinotomy.

Rhinoplasty and Nasal Repair

  • 30400: Rhinoplasty, involving tip and/or lateral alar cartilages.
    • For columellar reconstruction, see 13151 et seq.
  • 30410: Rhinoplasty, including bony pyramid, lateral and alar cartilages, and/or elevation of nasal tip.
    • CPT Assistant: Jan 21:13
  • 30420: Rhinoplasty, complete, primary, major revision involving osteotomies.
  • 30430: Rhinoplasty, secondary, minor revision (small amount of nasal tip work).
  • 30435: Rhinoplasty, secondary, major revision involving osteotomies. (nasal tip work and osteotomies).
  • 30450: Rhinoplasty for nasal deformity secondary to congenital cleft lip and palate, including columellar lengthening and wedge excisions of nasal alae.
  • 30460: Rhinoplasty for nasal deformity secondary to congenital cleft lip and palate, including columellar lengthening, tip, septum, and osteotomies.
    • CPT Assistant: Dec 14 18
  • 30465: Repair of nasal vestibular stenosis (e.g., spreader grafting, lateral nasal wall reconstruction).
    • CPT Changes: An Insider's View 2001
    • CPT Assistant: Sep 20, Feb 23, Mar 24
    • (Do not report 30465 in conjunction with 30468 or 30469 when performed on the ipsilateral side.)
    • (30465 excludes obtaining grafts. For graft procedures, see 15769, 20900, 20902, 20910, 20912, 20920, 20922, 20924, 21210, 21235)
    • (For repair of nasal vestibular lateral wall collapse with subcutaneous/submucosal lateral wall implant(s), use 30468)
    • (For repair of nasal valve collapse with low energy, temperature-controlled (i.e., radiofrequency) subcutaneous/submucosal remodeling, use 30469)
    • 30465 is used to report a bilateral procedure. For a unilateral procedure, use modifier 52.
  • 30468: Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implants.
    • CPT Assistant
    • Do not report 30468 in conjunction with 30465 or 30469 when performed on the ipsilateral side.
  • 30469: Repair of nasal valve collapse with low energy, temperature-controlled (i.e., radiofrequency) subcutaneous/submucosal remodeling.
    • CPT Assistant: Feb 23
    • Do not report 30469 in conjunction with 30465 or 30468, when performed on the ipsilateral side.
    • 30469 is used to report a bilateral procedure. For a unilateral procedure, use modifier 52.

Septoplasty and Intranasal Procedures

  • 30520: Septoplasty or submucous resection, with or without cartilage scoring, contouring, or replacement with graft.
    • CPT Assistant: Oct, Dec, Mar, Jul, Jul, Jan, Feb, Jul
  • 30540: Repair of choanal atresia, intranasal.
  • 30545: Repair of choanal atresia, transpalatine.
  • 30560: Lysis of intranasal synechiae (scars),
  • 30580: Repair nasal fistula (Maxilla) (Can be combined with 31030 if antrotomy is included).
  • 30600: Septal or other intranasal dermatoplasty (does not include obtaining graft).
  • 30630: Repair of nasal septal perforations.
    • CPT Assistant: Aug

Turbinate Procedures

  • 30801: Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (e.g., electrocautery, radiofrequency ablation, or tissue volume reduction),
    • CPT Changes: An Insider's View 2002, 2006, 2010
    • CPT Assistant:
    • (For ablation of superior or middle turbinates, use 30999)
  • 30802: Ablation, soft tissue of inferior turbinates, intramural (i.e., submucosal).
    • CPT Changes: An Insider's View 2010
    • CPT Assistant: Mar, Sep, Jul, Feb
    • Do not report 30801 in conjunction with 30802.
    • Do not report 30801, 30802, or 30930 in conjunction with 30130 or 30140.
    • For cautery performed for control of nasal hemorrhage, see 30901-30906.

Control of Nasal Hemorrhage

  • 30901: Control of nasal hemorrhage, anterior, simple (limited cautery and/or packing), any method
    • CPT Assistant: Jul, Oct
    • To report a bilateral procedure, use 30901 with modifier 50.
  • 30903: Control of nasal hemorrhage, anterior, complex (extensive cautery and/or packing), any method.
    • To report a bilateral procedure, use 30903 with modifier 50.
  • 30905: Control of nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method, initial.
    • CPT Changes: An Insider's View 2002
    • CPT Assistant: Sep
  • 30906: Control of nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method, subsequent.

Ligation of Arteries

  • 30915: Ligation of arteries, ethmoidal.
  • 30920: Ligation of the internal maxillary artery, transantral.
    • For ligation of the external carotid artery, use 37600.

Fracture of Nasal Turbinates

  • 30930: Fracture of nasal inferior turbinate(s), therapeutic.

    • CPT Changes: An Insider's View 2006
    • CPT Assistant: Jul, Dec, Jul, Aug, Dec, Sep, Jul
    • (Do not report 30801, 30802, 30930 in conjunction with 30130 or 30140)

  • (For fracture of superior or middle turbinate[s), use 30999)

Unlisted Procedures

  • 30999: Unlisted procedure, nose.
    • CPT Assistant: Feb, Nov, Sep, Jan, Jan, Feb

Accessory Sinuses - Incision

  • 31000: Lavage by cannulation: maxillary sinus (antrum puncture or natural ostium).
    • CPT Assistant
    • To report a bilateral procedure, use 31000 with modifier 50.
  • 31002: Lavage by cannulation: sphenoid sinus.

Sinusotomy

  • 31020: Sinusotomy, maxillary (antrotomy), intranasal.
    • To report a bilateral procedure, use 31020 with modifier 50.
  • 31030: Sinusotomy, maxillary (antrotomy), radical (Caldwell-Luc) without removal of antrochoanal polyps.
    • To report a bilateral procedure, use 31030 with modifier 50.
  • 31032: Sinusotomy, maxillary (antrotomy), radical (Caldwell-Luc) with removal of antrochoanal polyps.
    • To report a bilateral procedure, use 31032 with modifier 50.
  • 31040: Pterygomaxillary fossa surgery, any approach.
    • For transantral ligation of internal maxillary artery, use 30920.
  • 31075: Sinusotomy, sphenoid, with or without biopsy, mucosal stripping, or removal of polyps.
  • 31080: Sinusotomy, frontal; external, simple (trephine operation).
    • (For frontal intranasal sinusotomy, use 31276)
  • 31081: Sinusotomy frontal; transorbital, unilateral (for mucocele or osteoma, Lynch type).
  • 31084: Sinusotomy, frontal; obliterative without osteoplastic flap, brow incision (includes ablation).
  • 31085: Sinusotomy, frontal; obliterative without osteoplastic flap, coronal incision (includes ablation).
  • 31086: obliterative, with osteoplastic flap, brow incision (includes ablation).
  • 31087: obliterative, with osteoplastic flap, coronal incision (includes ablation).
  • 31090: Sinusotomy, unilateral, three or more paranasal sinuses (frontal, maxillary, ethmoid, sphenoid).
    • CPT Assistant: Nov, Nov

Ethmoidectomy

  • 31200: Ethmoidectomy; intranasal, anterior.
    • CPT Assistant: Feb
  • 31201: Ethmoidectomy; intranasal, total.
    • CPT Assistant: Feb
  • 31205: Ethmoidectomy; external, total.
    • CPT Assistant: Feb

Maxillectomy

  • 31225: Maxillectomy, without orbital exenteration.
  • 31230: Maxillectomy, with orbital exenteration (en bloc).
    • (For orbital exenteration only, see 65110 et seq)
    • (For skin grafts, see 15120 et seq)

Endoscopy -Nasal/Sinus

  • Surgical sinus endoscopy includes a sinusotomy (when appropriate) and diagnostic endoscopy.
  • Codes 31295-31298 describe dilation of sinus ostia by displacement of tissue, any method, and include fluoroscopy if performed.
  • Stereotactic computer-assisted navigation may be used to facilitate the performance of endoscopic sinus surgery and may be reported with G0178.
  • Codes 31233-31298 are used to report unilateral procedures unless otherwise specifies.

Diagnostic Endoscopy

  • Codes 31231-31235 for diagnostic evaluation refer to using a nasal/sinus endoscope to inspect the interior of the nasal cavity, middle and superior meatuses, the turbinates, and the spheno-ethmoid recess.

  • Any time a diagnostic evaluation is performed all these areas would be inspected and a separate code is not reported for each area.

  • To report these service when all of the elements are not fully examined (e.g., judged not clinically pertinent), or because the clinical situation precluded such exam (e.g., technically unable, altered anatomy), append modifier 52 if repeat examination is not planned, or modifier 53 if repeat examination is planned.

  • 31231: Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure).

    • CPT Assistant:

  • 31233: Nasal/sinus endoscopy, diagnostic with maxillary sinuscopy (via inferior meatus or canine fossa puncture).

    • CPT Changes: An Insider's View 2020
    • CPT Assistant: Winter, Jan, Jun, Apr
    • (Do not report 31233 in conjunction with 31256, 31267, 31295, when performed on the ipsilateral side)

  • 31235: Nasal/sinus endoscopy, diagnostic with sphenoid sinuscopy (via puncture of sphenoid face or cannulation of ostium).

    • CPT Changes: An Insider's View 2020
    • CPT Assistant: Winter, Jan, Apr
    • (Do not report 31235 in conjunction with 31257, 31259, 31287, 31288, 31297, 31298, when performed on the ipsilateral side)
    • To report endoscopic placement of a drug-eluting implant in the ethmoid sinus without any other nasal/sinus endoscopic surgical service, use 31299. To report endoscopic placement of a drug-eluting implant in the ethmoid sinus in conjunction with biopsy, polypectomy, or debridement, use 31237.

  • 31237: Nasal/sinus endoscopy, surgical with biopsy, polypectomy, or debridement (separate procedure)

    • CPT Assistant: Winter, Jan, Dec, May, Dec, Jan, Feb, Apr, Apr, Jul, Jan, Jul, Nov, Feb, Jul
    • Do not report 31237 in conjunction with 31238, 31253, 31254, 31255, 31256, 31257, 31259, 31267, 31276, 31287, 31288, 31290, 31291, when performed on the ipsilateral side)

  • 31242: Nasal/sinus endoscopy, surgical, with destruction by radiofrequency ablation, posterior nasal nerve.

    • CPT Changes: An Insider's View 2024
    • CPT Assistant Dec 23

  • 31243: Nasal/sinus endoscopy, surgical, with destruction by cryoablation, posterior nasal nerve.

    • CPT Changes: An Insider's View 2024
    • CPT Assistant Dec 23

  • 31238: Nasal/sinus endoscopy, surgical, with control of nasal hemorrhage

    • CPT Changes: An Insider's View 1002
    • CPT Assistant Winter, Jan, Apl
    • Do not report 31238 in conjunction with 31237 or 31241 when performed on the ipsilateral side

  • 31239: Nasal/sinus endoscopy, surgical, dacryocystorhinostomy.

    • CPT Assistant Winter, Jan, Apl

  • 31240: Nasal/sinus endoscopy, surgical, with concha bullosa resection.

    • CPT Assistant Winter, Jan, May, Feb, Apl

  • 31241: Nasal/sinus endoscopy, surgical, with ligation of sphenopalatine artery.

    • CPT Changes: An Insider's View 2018
    • CPT Assistant Apr
    • Do not report 31241 in conjunction with 31238 when performed on the ipsilateral side

Ethmoidectomy Procedures-Endoscopic

  • 31253: Nasal/sinus endoscopy, surgical with ethmoidectomy

    • (anterior).
    • CPT Changes: An Insider's View 2018
    • CPT Assistant Jan, Sep, Oct, Dec, May, Jul, Feb, Apr
      (Do not report 31254 in conjunction with 31237 31253,
    • When performed on the ipsilatcral side)

  • 31255: Nasal/sinus endoscopy, surgical with ethmoidectomy

    • (Anterior and posteriori).
    • CPT Changes: An Insider's View 2018
    • CPT Assistant Winter, Jan, Dec, May, Jul,Feb,Apr
      Do not report 31255 in conjunctionwith 31237 . when performed on the ipsilateral side

  • 31256: Nasal/sinus endoscopy, surgical with ethmoidectomy

    • (anterior and posteriori, with frontal sinus exploration, with removal of tissue from frontal sinus, when performed)
    • CPT Assistant - Apr, Apr , Dec
      too not report 31253 in conjunction with 31237. 31254.
      .When performed on the ipsilateral side

  • 31257: Nasal/sinus endoscopy, surgical with ethmoidectomy

    • -(anterior and posterior, with sphenoidotomy)
    • CPT Changes An Insider's View2018
    • CPT Assistant Ap
      not report 31257 in caoi1mct100 w1Jb
      when performed on the ipsilatera side!

  • 31259: Nasal/sinus endoscopy, surgical with ethmoidectomy

    • (anterior and posteriori, with sphenoidotomy, with removal of tissue from the sphenoid sinus)

    • CPT Assistont Apr, AP, Dec
      [Jo not report 31259 io conIuncr1on ,when performed on the Ipsilateral side

  • 31267: Na-sal/s1nus endoscopy. surgical. with maxullary antrostomy,

    • CPT AssistantWintl!l,Jan , Jun, Jul, Ail
      (Oo not report 31256 in conjunction with 312]3 when performed on the ipsilateral side I

  • 31276: Nasal/smus endoscopy, surgical. frontal sinus exploration. 111clud1”9 removal of tissue from frontal sinus. when performed
    CPT. AlllllSJder'S VIBW2018
    CPT Assistantsistant W«nter , Jan, Jun,
    (Do not report 31276 m con1unction wjthwhen performed on the jpsilaleral

  • 31287: Nasal/smus endoscopy, surg1cal, @ll spheno1dotomy;

    • CPT Ass1st.tnt Apr .1819 10

  • 31288: Nal/sinus endoscopy, surgical, gjltl removal of tissue from the sphenoid sinus

  • 31290: Nasal/sinus endoscopy, surg1cal, r~ rebrosprnal llutd teak region
    CPT As.sisran Apr. Apr (Do not report 31290 rn conIunctionwben performed on the 1psrla1eral s1del

  • 31291: Nasal/sinus endoscopy, surgical. sphenord region -5

  • 31292: Nasall sinus endoscopy. surgrcal, ~al (fecompress1on; medial@inferior wall

  • 31293: medial and inferior wall
    CPT Changes An ~ i Voew202D

  • 31294: Nasal/sinus_endoscopy, surgical, ~ h optic ner::,e decompression

    • * (Q,o not report 31294 in conjunct,on with 31237, 3)153,31254.when performed on the 1ps1lateral side

  • 31295: Nasal/sinus endoscopy, surgical, wrth drlation (eg, balloon dilation); maxillary sinus ostium.transnasal or via canine lossa"

    • re ort 31295 in con unction with when performed on the 1psilatera s1

Larynx Excision

  • 31300: Laryngotomy (thyrotomy, laryngofissure) with r~of tumo laryngocecordectomy .
  • 31360: Laryngectorny total without radical neck dissection.
    CPT Assisranr Aug
  • 31365: ti radical neck dissection
    CPT Oct Aug HJ,
    31367: \
    suragltic without radical neck dissection.
    CPT Assistant Aug·
    supraglottic. - radical neck d1ssect1on

Laryngectomy procedures

  • 31370: Eartial laryngectomy (hem1laryngectomy); horizontal.
  • 31375: laterovertical.
  • 31380: anterovertical.
  • 31382: antero-latero-vertical.
  • 31390: Pharyngolaryngectomy. radical neck d1ssect100 without reconstruction.Vii1b reconstruction.
  • 31395: Arytenoidectomy 01 .
    . Yh
    dae MU. muscles
    (For emiloscop1c atyt no,ifeclomy use 31 60)
    Epiglo!!jdectomy .Z.S.I

Larynx Introduction

  • 31500: Intubation. endotracheal. emergency procedure.
    • CPT Assistant Nov 99, Oct, Aug, Jul, Dec
  • 31502: Tracheotomy tube change pnor to establishment of fistula tract.
    • CPT Assistant Winter 90 6. Dec

Larynx Endoscopy

  • For endoscopic procedures report appropriate endoscopy of each anatomic site examined. Laryngoscopy includes cxaminadon of the tongue base, larynx and hypopharynit.
    The anatomic structures examined with chis procedure include both midline (single anatomic sites) and paired srructures. Midline single anatomic sites include tongue base, vallecula, epiglottis, subglonis and posterior pharyngeal wall Paired structures include: true vocal cords, arytcnoids, false vocal cords, ventricles pyriform sinuses and aryepiglouic folds For the purposes-of reporting therapeutic inrervcnrions, all paired structures contained within o ne side of the larynx
    pharynx are considered unilateral. If using operating microscope, telescope, or both, use the applicable code only once per operative session.

  • 31505: diagnostic (se~rate procedure).
    CPT C~s: An Insider's View 2000
    CPT Assistanl Nov 99

  • 31510: with biopsy b.
    CPT Assistant Nov 99

  • 31511: with removal of foreign body
    CPT Assistant Nov
    31512.

  • 31513: Laryngoscopydirect with vocal cord injection
    CPT Assistant Nov

  • 31515: LaryngoscopY direct with or without tracheoscopy for a~irat1on.

  • 31520: diagnostic
    (Do not report modifier 63 in conjunction with 31520

  • diagnostic.e
    t newb Q1Tl
    CPT Assistant Aug

  • 31526: diagnostic operating m1croscop~ elescope CPT Changes· An lns1df'('s V1ew2006 d
    CPT Ass, Nov98 -12. Jun 17 10
    (Do not report 31526 m conjuncuoo w11h 6999.l)

  • 31527: inwert1on of obturator
    CPT Changes· An lns,cJe, 's V,ew 2002 insert1on subsequentV
    CPT Ass,srant Nov

  • 31530: Laryngoscopy direct operative. foreign's.

  • 31531: irect operative. with operatingmicroscope telesco CPT Changes.· An lns,der's~1000
    (O17
    CPT AssNovJun Nov

  • 31535: laryngoscopy
    B. with biopsy bx SiC

  • 31536: operating microscope. telescope CPT Changes. An lnsder 's Vrew2006
    CPT Ass, NovMay -(O11
    (Do not re rt code 69990 in addition to code 315361
    31540 laryngoscopy direct operative. excision

  • 31541: operating telescopeC
    CPTOm's V
    . C1'TAssiram NoJ 98 -12. Jun Jul 19 10

Laryngoscopy with the removal of minor lesions

  • 31545: submucosal removal of non-neopfastic les of vocal cord. reconstruc,ion local tissue flap(s) C1'i C~rs mder-vs 2005

Laryngy reconstruction procedures

  • 31546:reconstructmn h graft(s includes obtaining autograft. CPT Changes. An lrwdtrs v- 2005
    (Do not report 311withallograft
    3154 report lO conjunctioo witb -

  • 31560: ~ryngoscopy Q!!!CC .aryteno1dectomy. CPTAssApr'
    with microscope.telescopeo ~ lo.
    CPT Changes· An lnstder'sView2006 lo.~ -
    CPT AssNovJun

Laryngoscopy and injection Therapy

  • 31570: laryngostopy direct inject or 10. U
    0 Cl'T Ass,stanr Jan 14 6 Jan 17 6
    CPT Changes An Insider's V1ew2006
    C1'T Ass11-12Nov 12 14. Jan 14 6 Jan 17 6 jun

  • 31575:1.aiyngoscopy. fdiagnostic CPT Changes:An~V1ew2017
    Q O'T AsSlsrnO
    (Oo not report. unless tndowl

  • 31576: OX
    CPTChangesAnlnsider'sView2017
    0 Cl'T Assistant Dec
    (Do not report with
    foreign Cnr
    CPJ. Changes: An Insider's View2017

  • 31578: removal of lesionis) CPT Assistant Dec, APR,Jul
    with of with laser unilateral CPT Changes An Insider's
    CPT Assistant APR Jul Sep

  • 31579: h injection
    s~ transoral, or via endoscope channel), unilateral CPT Changes An Insider's Vien Dec16.13 Apr h injection augmentation(eg, perctaneous,transorall. Q_0
    ( eg, CPrChanges v,ew2017 CPT Assistant APR Jul . C
    •Laryngoscopy. tlex1ble or rigid telescopic, with S211 strobos~opy0.TY
    0 Cl'TChanges. An Insider's View 2017

Laryngoplasty and Surgical Stenting of the Larynx

  • 31580: laryngoplasty for laryngeal web~ indwelling keel stent insertion.
    CPT Assistant Mar, Apr

Code Changes

(To report tracheostomy. see 31600, 31601, 31603, 31605. 31610)
(To report removal of the keel or stent. use 31599)

  • 31551: for Indwelling CPT Changes An Aug
    laryngoplasty
    (To report tracheostomy. see 31600, 31601, 31603
    _s
    s. Yilf graft, for stenosis stenosis 48 with CPT Ch anges · An Insider’s Vievv
    CPT Assistant Mar. Afl'I . lul
    15801
    (To ~eport tracheostomy

  • # 31553:
    fbr Indwelling YS stent placement age 12 years and older (Oo not report
    graft separately if ha rvested through.
    the