Description of code 31242 and 31243

CPT code 31242 and 31243 are established from 2024 for reporting endoscopic energy-based neurolysis of the posterior nasal nerve.  Below is the description of the new cpt codes.

30117   Excision or destruction (eg, laser), intranasal lesion; internal approach

30118  external approach (lateral rhinotomy)

31237   Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)

31242   with destruction by radiofrequency ablation, posterior nasal nerve

 31243   with destruction by cryoablation, posterior nasal nerve

CPT codes 31242 and 31243 have been established to report nasal/sinus endoscopic destruction of the posterior nasal nerve using radiofrequency ablation (Procedure code 31242) or cryoablation (Procedure code 31243). Prior to 2024, there were no codes for reporting energy-based destruction of the posterior nasal nerve.

CPT code 30117 describes the excision or destruction of an intranasal lesion using an internal approach; however, it does not include an endoscopic approach or specify radiofrequency or cryoablation of the posterior nasal nerve.

Codes 31242 and 31243 describe bilateral procedures. When performed unilaterally, modifier 52, Reduced Services, should be appended as noted in a new instructional parenthetical note following codes 31242 and 31243. An exclusionary parenthetical note has been added to restrict the use of codes 31242 and 31243 with codes 31231 and 92511.

The following clinical examples and procedural descriptions reflect typical clinical scenarios for which these new codes would be appropriately reported.

Clinical Example (31242)

A 68-year-old female presents with symptoms of chronic rhinitis that have been refractory to medical therapy. The patient is scheduled for endoscopic surgical energy-based neurolysis of the posterior nasal nerve, using a radiofrequency ablation probe.

Description of Procedure (31242)

Remove previously placed pledgets. Perform the following portions of the procedure under endoscopic visualization. Place additional pledgets soaked in decongestant and anesthesia more posteriorly in the middle meatus, followed by a wait time for them to take effect. Then remove the pledgets. Place pledgets soaked in decongestant and anesthesia at the lateral attachment site of the middle turbinate followed by a wait time for them to take effect. Inject an intranasal anesthetic or vasoconstrictive agent into the lateral attachment of middle turbinate followed by a wait time for this to take effect. Medialize the middle turbinate.

Introduce the radio frequency energy delivery device into the nasal cavity. Perform multiple applications of radio frequency in the area of the posterior nasal nerve, including the lateral attachment of the middle turbinate as well as the superior aspect of the inferior turbinate. Withdraw the radio frequency delivery device. Place pledgets soaked in decongestant in the treated areas to allow for hemostasis. Then remove the pledgets. Perform the same procedure on the contralateral side.

Clinical Example (31243)

A 72-year-old female presents with symptoms of chronic rhinitis that have been refractory to medical therapy. The patient is scheduled for endoscopic surgical energy-based neurolysis of the posterior nasal nerve, using a cryoablation probe.

Description of Procedure (31243)

Remove previously placed pledgets. Perform the following parts of the procedure under endoscopic visualization. Place pledgets soaked in decongestant and anesthesia in the middle meatus followed by a wait time for them to take effect. Then remove the pledgets. Place pledgets soaked in decongestant and anesthesia at the lateral attachment site of the middle turbinate followed by a wait time for them to take effect. Inject an intranasal anesthetic or vasoconstrictive agent into the lateral attachment of middle turbinate followed by a wait time for this to take effect. Medialize the middle turbinate. Introduce the cryoablation probe into the nasal cavity. Then place the cryoablation probe at the lateral attachment of the middle turbinate and activate, initiating the freezing process.

Perform cryotherapy freezing under scrupulous endoscopic observation. Once adequate cryotherapy has been applied, stop the application of cryotherapy. Ask the patient to breathe through their nose while the cryotherapy probe unfreezes from the affected mucosa. Once the cryotherapy probe unfreezes from the surrounding mucosa, withdraw it. Then place pledgets soaked in decongestant in the treated areas to allow for hemostasis. Remove the pledgets. Exchange the cryoablation canister for a new one. Reorient the wand to accommodate the contralateral side. Perform the same procedure on the contralateral side.

Reference : CPT assistant December edition