Nasal endoscopy is a common medical procedure that provides a detailed, magnified view of the nasal cavity and the openings to the paranasal sinuses. This examination is performed by inserting a thin tube, equipped with a light source and a camera, directly into the nostrils. The endoscope allows a physician to visualize structures that are otherwise obscured by a standard anterior nasal examination, offering a clear, real-time assessment of the anatomy and any potential pathology present in the passages. It serves as a diagnostic tool for evaluating a variety of sinonasal complaints.
The Two Core Categories of Procedures
The range of nasal endoscopy procedures is broadly organized into two core categories, reflected in the Current Procedural Terminology (CPT) codes 31231 through 31298: Diagnostic Nasal Endoscopy and Therapeutic or Surgical Nasal Endoscopy. The fundamental difference lies in the intent of the procedure, which is either observation or active intervention. Diagnostic procedures are primarily exploratory, while therapeutic procedures involve performing a corrective action or surgery.
Diagnostic Endoscopy: Purpose and Scope
Diagnostic Nasal Endoscopy is primarily represented by CPT codes 31231-31235. The physician uses this procedure to identify the cause of chronic symptoms such as persistent nasal congestion, facial pressure, or loss of smell. Issues assessed include chronic inflammation, nasal polyps, structural abnormalities, or the source of recurrent epistaxis (nosebleeds). The procedure is typically quick, lasting five to thirty minutes, and is usually performed in an office setting. The patient is often seated upright while the nasal passages are prepared with a topical decongestant and a topical anesthetic.
Therapeutic Endoscopy: Surgical Applications
Therapeutic or Surgical Nasal Endoscopy, encompassing CPT codes 31237-31298, goes beyond visualization to include active intervention. These procedures are often associated with Functional Endoscopic Sinus Surgery (FESS), a technique aimed at restoring normal sinus function. The range of interventions is extensive, including the removal of tissue or foreign bodies, biopsy, controlling hemorrhage, or widening the natural sinus drainage pathways. Procedures under this category might involve an ethmoidectomy, which is the removal of diseased ethmoid air cells, or balloon dilation, which expands the openings of the frontal or sphenoid sinuses. Due to the complexity and need for greater patient comfort and immobility, these surgical procedures are typically performed in an operating room setting, often requiring general anesthesia or heavy sedation.
Patient Experience: Preparation and Recovery
Patient preparation begins with a discussion about current medications, particularly blood thinners, which may need to be temporarily discontinued before a surgical procedure. For simple diagnostic procedures, patients may be asked to avoid eating or drinking for a short period if mild sedation is anticipated. The recovery experience differs significantly between the two types of procedures. Following a diagnostic endoscopy, patients can typically return to their normal activities immediately, with minor side effects resolving within a couple of days. In contrast, therapeutic or surgical endoscopy procedures require a more substantial recovery period, often involving several days to a few weeks of restricted activity as the surgical site heals.