Coding for a Fess Procedure

Question:

What is the recommended CPT coding for a nasal/sinus endoscopy with a total ethmoidectomy, frontal sinus exploration with removal of tissue from frontal sinus, a sphenoidotomy with removal of tissue from sphenoid, and a maxillary antrostomy with removal of tissue from maxillary sinus?

Answer:

For a functional endoscopic sinus surgery (FESS) involving the procedures you listed, the recommended CPT codes are:

• Total ethmoidectomy (anterior + posterior): 31259 – Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior and posterior) including sphenoidotomy, including removal of tissue from the sphenoid sinus.

• Frontal sinus exploration with removal of tissue: 31276 – Nasal/sinus endoscopy, surgical; with frontal sinus exploration, including removal of tissue from frontal sinus.

• Maxillary antrostomy with removal of tissue: 31267 – Nasal/sinus endoscopy, surgical; with maxillary antrostomy, with removal of tissue from maxillary sinus.

CPT code 31259 is a combination code that includes anterior and posterior ethmoidectomy and the sphenoidotomy which includes the removal of tissue from the sphenoid sinus. These codes are separate and distinct procedures because they involve different sinus cavities, so they are typically reportable together (when medically necessary and documented). If performed bilaterally, append modifier -50 (or follow payer-specific bilateral reporting rules). The “with removal of tissue” codes (31267, 31276, 31259) are appropriate since tissue removal is documented. Do not separately report diagnostic endoscopy (31231) — it is included in the surgical procedures.

*This response is based on the best information available as of 06/04/26.