CPT® Code 31293

A surgical nasal/sinus endoscopy is a minimally invasive procedure that involves the use of an endoscope to visualize and treat conditions affecting the nasal cavity and paranasal sinuses. In the context of CPT® Code 31293, this procedure specifically includes the surgical decompression of both the medial and inferior walls of the orbit, which is the bony structure surrounding the eye. The procedure begins with the application of a topical nasal decongestant and a local anesthetic, often combined with a vasoconstrictor to minimize bleeding and enhance visibility during the surgery. An endoscope, a thin, flexible tube equipped with a camera and light source, is then inserted through the nostrils to allow the surgeon to inspect the nasal passages and sinuses for any signs of disease or abnormalities. During the procedure, the ethmoidal air cells, which are small cavities located between the nose and the eyes, are cleared to improve drainage and reduce the risk of infection. The surgeon carefully exposes the medial orbital wall, which is the inner wall of the eye socket, and thins it using a specialized tool called a burr. This step is crucial for safely accessing the orbital contents. Elevators are then employed to open the medial orbital wall, and the lamina papyracea, a thin bony structure that separates the orbit from the sinuses, is removed to facilitate further decompression. For the inferior orbital wall, the procedure follows a similar approach, where the lamina papyracea is traced to the roof of the maxillary sinus. The floor of the orbit, or inferior orbital wall, is then thinned and opened using an elevator, allowing for effective decompression. Additionally, incisions made in the orbital periosteum, the connective tissue surrounding the bones of the orbit, enable orbital fat to prolapse, further relieving pressure on the orbital contents. It is important to note that CPT® Code 31293 is specifically designated for cases where both the medial and inferior orbital walls are decompressed, distinguishing it from CPT® Code 31292, which is used when only one of these walls is addressed.