CPT® Code 31290

A surgical nasal/sinus endoscopy is a minimally invasive procedure that allows for direct visualization and intervention within the nasal cavity and paranasal sinuses. Specifically, this procedure involves the repair of a cerebrospinal fluid (CSF) leak, which is a condition characterized by the leakage of CSF from the cranial cavity into the nasal passages, commonly referred to as CSF rhinorrhea. The ethmoid region, which is located between the nose and the brain, is a frequent site for such leaks, particularly through the cribriform plate. During the procedure, a topical nasal decongestant may be applied to reduce swelling and improve visibility, while a local anesthetic with a vasoconstrictor is utilized to minimize discomfort and bleeding. An endoscope, a thin, flexible tube equipped with a camera and light, is introduced through the nostril to inspect the nasal cavity and the surrounding sinuses for any abnormalities or disease. Once the site of the CSF leak is identified, the surgeon repairs the defect using either fat or muscle tissue to effectively plug the leak. This plug is then secured with fascia to ensure stability. In cases of larger CSF leaks, a cartilage autograft may be necessary to reinforce the repair, providing additional support to prevent future leaks. The use of CPT® Code 31290 specifically denotes the surgical repair of a CSF leak located in the ethmoid region, distinguishing it from similar procedures performed in other areas, such as the sphenoid region, which is reported using CPT® Code 31291.