E844

PDF page 646 / P6

RESPIRATORY SURGICAL PROCEDURES
ACCESSORY NASAL SINUSES
                                                                                                        Asst         Surg          Anae
    ACCESSORY NASAL SINUSES – ENDOSCOPIC APPROACH
# Z318 Trephine or endoscopic frontal sinusotomy (e.g., Draf I or Draf
          IIA)......................................................................................                 133.30          7
# M054 Intranasal maxillary antrostomy – unilateral – by endoscopic or
          endonasal approach...........................................................                    6         123.70          10
# M050 Frontal sinusotomy (e.g., Draf IIB or Draf IIC), unilateral .......                                           350.00          10
# E865    - bilateral procedure, to M050 ...................................... add                                  200.00
# M052 Median frontal sinusotomy (e.g., Draf III / Modified Lothrop)                                                 660.20          10
    Ethmoidectomy/Antrostomy
# M083 Intranasal ethmoidectomy, may include maxillary antrostomy,
          with endoscope – unilateral (not eligible for payment with
          M061 or M054) ...................................................................                          350.00          10
# E844    - bilateral procedure, to M083 ...................................... add                                  200.00
         Payment rules:
         1.M083 is only eligible for payment in addition to M050 or M052 when endoscopic intranasal
           ethmoidectomy is medically necessary to treat ethmoid sinus pathology. Ethmoidectomy
           performed for surgical access is not eligible for separate payment.

Master, record 1538. Record Layout PDF, page 1.

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