CPT® Code 31291

A surgical nasal/sinus endoscopy is a specialized procedure that involves the use of an endoscope to visualize and access the nasal cavity and paranasal sinuses. This particular procedure, identified by CPT® Code 31291, specifically addresses the repair of a cerebrospinal fluid (CSF) leak located in the sphenoid region. A CSF leak, often referred to as CSF rhinorrhea, occurs when there is a breach in the protective barrier surrounding the cerebrospinal fluid, leading to fluid leakage into the nasal passages. The procedure typically begins with the application of a topical nasal decongestant and a local anesthetic, often combined with a vasoconstrictor, to minimize bleeding and discomfort during the surgery. Once the area is adequately prepared, an endoscope is carefully introduced through the nostril, allowing the surgeon to inspect the nasal cavity and the surrounding sinuses for any signs of disease or abnormalities. Upon locating the site of the CSF leak, the surgeon proceeds to repair the defect using either fat or muscle tissue, which serves as a plug to seal the leak. This plug is then covered with fascia to ensure stability and promote healing. In cases where the CSF leak is particularly large, a cartilage autograft may be utilized to reinforce the repair, providing additional support to prevent future leaks. It is important to note that while CPT® Code 31291 is designated for repairs in the sphenoid region, a different code, CPT® Code 31290, is used for repairs of CSF leaks in the ethmoid region, which includes those that occur through the cribriform plate.