# Septoplasty or Rhinoplasty?



## Kevinph84 (May 17, 2010)

I have two cases that has me confused. Both cases were done for acquired nasal deformities causing obstruction, secondary to trauma.

Case # 1

Provider Performed:
1.) ORIF Nasal Septal Fractures
2.) Reconstruction of Nasal Tip using Tip and Columella Graft
3.) Reconstruction of Middle Vault on the Left with Spreader Grafts
4.) Correction of Dorsal Deformity with Radix Graft
5.) Lateral Fracture and Cauterization of Inferior Turbinates
6.) Reduction of Right Middle Turbinate

Case # 2

Provider Performed:
1.) ORIF Nasal Septal Fractures
2.) Correction of External Vault using Tip and Columella Graft
3.) Reconstruction of Middle Vault on the Left with Spreader Grafts
4.) Insertion of Radix Graft
5.) Lateral Fracture and Cauterization of Inferior Turbinates


The other party is billing the above cases as 21335, 30465, and 20912 x2

I feel 30930 applies for the outward fracturing on the turbinates. I am torn between coding procedures 30520 (septoplasty) and 30420 (Rhinoplasty, primary, including major septal repair). I do not feel all the grafting is appropriate to bill because both of these codes include the grafting. Also both codes include 21335. Now 30520 does fall into 30420. I'm not sure which one is more appropriate. Does anyone have an idea? Thank you all for your help.


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## capricew (May 18, 2010)

Nothing in which you have provided describes recontruction of the septum, so septoplasty is out.  The septal fracture is covered by the 21335.

Rhinoplasty 30420, is out because it is covered with the 21335 and from what you provided a full rhinoplasty was not done, just tip work which would lead me to code 30400 but that bundles with 21335.

So for me, billing for an asc, i would have billed on a medicare pt:

30465   (if you bill for physician and this is done unilateral add  modifier -52)
21335  FOR ORIF NASOSEPTAL FX
20912  GRAFT TAKEN FROM SEPTUM
30930  FOR OUTFRACTURE OF INFERIOR TURBINATE
30999  FOR REDUCTION OF THE MIDDLE TURBINATE
L8699-GA  FOR THE RADIX GRAFT WHICH I ASSUME IS ALLOGENIC

it is very hard to properly justify any of these codes without the actual dictation to prove the work actually done.


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## Kevinph84 (May 19, 2010)

May I send you a scrubbed dictation for your opinion? Thank you so much.


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