What is the CPT (Current Procedural Terminology) code for a nonobliterative frontal sinusotomy with an osteoplastic (bone flap) brow incision?

CPT Code for Nonobliterative Frontal Sinusotomy with Osteoplastic Flap Brow Incision

The correct CPT code for a nonobliterative frontal sinusotomy with osteoplastic flap brow incision is 31087.

Understanding CPT Code 31087

CPT code 31087 specifically describes a frontal sinusotomy procedure that is:

• Nonobliterative (meaning the sinus cavity is preserved rather than obliterated)
• Performed with an osteoplastic flap approach
• Accessed through a brow incision

This code accurately captures the specific surgical technique described in the question, which involves creating a bone flap through a brow incision to access the frontal sinus without obliterating it.

Distinguishing Between Similar Frontal Sinus Procedures

To understand why 31087 is the correct choice, it's important to differentiate between the various frontal sinus procedure codes:

• 31080: Sinusotomy, frontal; obliterative, without osteoplastic flap, brow incision (includes ablation)
• 31081: Sinusotomy, frontal; obliterative, without osteoplastic flap, coronal incision
• 31084: Sinusotomy, frontal; obliterative, with osteoplastic flap, brow incision
• 31085: Sinusotomy, frontal; obliterative, with osteoplastic flap, coronal incision
• 31086: Sinusotomy, frontal; nonobliterative, with osteoplastic flap, brow incision
• 31087: Sinusotomy, frontal; nonobliterative, with osteoplastic flap, coronal incision
• 31090: Sinusotomy, unilateral, three or more paranasal sinuses (frontal, maxillary, ethmoid, sphenoid)

Key Factors in Code Selection

The two critical factors that determine the correct code in this case are:

1. Nonobliterative vs. Obliterative:

   • The procedure is described as nonobliterative, which means the frontal sinus is preserved rather than eliminated
   • This immediately rules out codes 31080,31081,31084, and 31085 (all obliterative procedures)

2. Incision Type:

   • The procedure uses a brow incision approach
   • This rules out code 31087 which uses a coronal incision

Based on these specific parameters, 31086 is the only code that correctly describes a nonobliterative frontal sinusotomy with osteoplastic flap using a brow incision.

Clinical Context

This procedure is typically performed for conditions requiring access to the frontal sinus while preserving its function, such as:

• Removal of frontal sinus lesions
• Management of complicated frontal sinusitis
• Repair of frontal sinus fractures
• Orbital roof decompression 1

The osteoplastic flap approach provides excellent exposure while allowing the bone flap to be replaced at the end of the procedure, maintaining the structural integrity and function of the frontal sinus.