# How would you code turbinates coblation, superficial nasal cautery & nasal endoscopy



## HCCCoder

*How would you code turbinates coblation, superficial nasal cautery & nasal endoscopy*

Can anyone help me with nasal procedures?
Pt's CC was nose bleed. Doctor did Nasal Endoscopy also Turbinates Coblation and Superficial Nasal Cautery on the same DOS.
How would you code this?
Would you code 31231, 30801 or 31231, 30801, 30901 (because of nose bleed).  

Thank you in advance for anyone who would answer to my question.


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## amitjoshi4

lmartirosyan said:


> Can anyone help me with nasal procedures?
> Pt's CC was nose bleed. Doctor did Nasal Endoscopy also *Turbinates Coblation* and Superficial Nasal Cautery on the same DOS.
> How would you code this?
> Would you code 31231, 30801 or 31231, 30801, 30901 (because of nose bleed).
> 
> Thank you in advance for anyone who would answer to my question.


 
Hi,

The appropriate codes in your case are 31238 and 30140-52, although the documentaion is not enough to clear the picture. Since the turbinates are coblated, they are shrunk in size and hence are reduced. The codes 30801, specifically tells about the *Mucosa* of Turbinates. Please go through this 

There are several key points to bear in mind when coding turbinate procedures. As such it is important to identify the type of turbinate procedure and the appropriate technique that is performed. 
• Chronic nasal obstruction due to inferior turbinate hypertrophy from multiple causes (allergy, rhinitis medicamentosa, vasomotor rhinitis, etc) 

• Chronic infection, or allergy with continuous or intermittent nasal symptoms 

• Turbinates that are obstructive and not responding to aggressive medical management may require surgical treatment. 

• *Turbinates may be reduced in size or removed by any one (or combination) of several modalities: resection / excision (with /without endoscopes), cauterizations, sub mucosal debridement, laser, trimming, cryotherapy, radiofrequency reduction or ablation.*

Endoscopic control of nasal hemorrage is 31238.

Thank You​[FONT=Times New Roman,Times New Roman] 
[/FONT]


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## HCCCoder

Thank you very much for your response and time!
I agree with 31238, but the 30140 is removal of part of all of the inferior turbinates.
Documentation states:

Turbinates coblation- Appropriate consent was abtained. Nose was decongested with neosynephrine 0.25% sprays. Followed by injection. Reflex wand 45 was inserted into each turbinate for 20 seconds per pass. 

Nasal Cautery- superficial electrocautery of bleeding turbinates were performed, after local anesthesia. 

Nasal Endoscopy- Rigid video nasal endoscopy with playback. Septum ulcerated to the left small active bleeding inferior turbinates erythema.

Would you still code 30140 with 31238, I think, 31238 needs to be coded with 30801, since the cautery was superficial. 

What do you think?


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## amitjoshi4

lmartirosyan said:


> Thank you very much for your response and time!
> I agree with 31238, but the 30140 is removal of part of all of the inferior turbinates.
> Documentation states:
> 
> Turbinates coblation- Appropriate consent was abtained. Nose was decongested with neosynephrine 0.25% sprays. Followed by injection. *Reflex wand 45* was inserted into each turbinate for 20 seconds per pass.
> 
> Nasal Cautery- superficial electrocautery of bleeding turbinates were performed, after local anesthesia.
> 
> Nasal Endoscopy- Rigid video nasal endoscopy with playback. Septum ulcerated to the left small active bleeding inferior turbinates erythema.
> 
> Would you still code 30140 with 31238, I think, 31238 needs to be coded with 30801, since the cautery was superficial.
> 
> What do you think?
> Lilit


 
Hi Lilit,

The documentation itself provides the solution. The *reflex wand 45* is used for turbinates reduction only.
*ReFlex Ultra® 45 Plasma Wand* 
The ReFlex Ultra 45 Plasma Wand is used for Coblation® Turbinate Reduction. The ReFlex Ultra 45 Plasma Wand combines controlled tissue removal and effective coagulative lesion formation. This device is used for submucosal tissue shrinkage in the nasal cavity.

Please click this link : http://www.arthrocareent.com/wt/page/reflex

Since there is no documentation of mucosa and wand is used to shrink the turbinates, basically the purpose is to reduce the volume of turbinates. 30140-52 is the correct choice for  reduction of turbinates. See the parenthesis below the 30140 code.

Thank You


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## HCCCoder

Dear Amit,
Thank you very, very much for your help.
I am little confused.
Please help me understand.
For Nasal endoscopy with playback, there is no mention of hemorrhage (this is a different one), don't I have to code 31231, since it is diagnostic?
Also, if the homorrhage is mentioned under nasal cautery, does it mean I need to code 31238?
Third, if there is no mention of Reflux Ultra 45 Plasma Wand, and it says "turbinate coblation", do I still have to code 30140?
Fourth, is "nasal cautery" included in 30140? (in my case Doctor documented that "nasal cautery" and "turbinate coblation" were done.
And finally, If I have only "nasal cautery" without "turbinate coblation", how should I code?
Thank you very much again for your help. 
I have this doctor, who only does these procedures and I need to make sure to code them right. 
Your help is greatly appreciated, I can't wait for your response.

Lilit


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## dmaec

lmartirosyan said:


> Can anyone help me with nasal procedures?
> Pt's CC was nose bleed. Doctor did Nasal Endoscopy also Turbinates Coblation and Superficial Nasal Cautery on the same DOS.
> How would you code this?
> Would you code 31231, 30801 or 31231, 30801, 30901 (because of nose bleed).
> 
> Thank you in advance for anyone who would answer to my question.



hi Lilit;
In this scenario (with the info given) I would use 31238 and 30801.  To me, 31231 is diagnostic.  I don't agree with the 30140 even with the modifier because it doesn't appear to me that there's a resection of anything. Per the coders desk reference for 30801/30802- *the phycisian uses electrocautery and/or ablation to reduce inflammation or removed excessive mucosa from the inferior nasal turbinates unilaterally or bilaterally.  Cauterization may be superficial in 30801 or may be placed deep in to the mucosa in 30802. Topical vasoconstrictive agents are applied to the nasal mucosa.  Excessive or hypertrophied mucosa is cauterized or ablated and may be excised. Postoperative bleeding is minimal and there is no need for intranasal packing*  There is no mention that it "has" to be done with a specific wand named "ReFlex Ultra® 45 Plasma Wand ". So in short - I agree with your last post on this issue - I think it should be 31238 with 30801.
_{thats my opinion on the posted matter}_


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## dmaec

lmartirosyan said:


> Dear Amit,
> Thank you very, very much for your help.
> I am little confused.
> Please help me understand.
> For Nasal endoscopy with playback, there is no mention of hemorrhage (this is a different one), don't I have to code 31231, since it is diagnostic?
> Also, if the homorrhage is mentioned under nasal cautery, does it mean I need to code 31238?
> Third, if there is no mention of Reflux Ultra 45 Plasma Wand, and it says "turbinate coblation", do I still have to code 30140?
> Fourth, is "nasal cautery" included in 30140? (in my case Doctor documented that "nasal cautery" and "turbinate coblation" were done.
> And finally, If I have only "nasal cautery" without "turbinate coblation", how should I code?
> Thank you very much again for your help.
> I have this doctor, who only does these procedures and I need to make sure to code them right.
> Your help is greatly appreciated, I can't wait for your response.
> 
> Lilit


I know you asked Amit for opinion on this but I thought I'd add my 3 pennies too. 
I would agree for Nasal Endoscopy without intervention, nose bleed - being only diagnostic, I'd be looking under codes 31231 - 31235 depending on what exactly was done.
Nasal Endoscopy 31238 if bleeding is stopped and documentation supports. If he's only doing the basics - again, depending on exactly what he's doing.
I don't agree with using 30140 for turbinate coblation - I'd be looking under the 30801/30802 codes turbinate coblation.
that being said - yes cautery is included in 30140
simple nasal cautery - I'd be looking under the 30901-30905 codes, depending.

One thing I've done when I wasn't "exactly" sure is, I've brought my CPT book and desk reference to the doctor and asked them to tell me which code(s) they're really doing.  After all, who better than the doctor to know what procedure they're doing! 

_{that's my opinion on the posted matter} _


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## HCCCoder

Dear Donna,
Thank you very much for your opinion.
It is greatly appreciated.
I don't see those Doctors that's why I can't ask.
I wish I could have!!!!!


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## dmaec

oh, that makes it tough when you aren't able to question the docs.  Maybe you could call or email him the question, give him the codes with definitions - tell him you want to be sure you're capturing all of his charges(they like to know they're being paid for their services)  Most providers don't mind being asked for clarification of services. If these are the "only" procedure he does, he'll know which procedure codes to use. (of course sometimes something might change due to issue but I'm sure he'll document that as well).  
_{that's my opinion on the posted matter}_


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## HCCCoder

I am going to type exactly how it appears on the progress note.
Nasal Endoscopy
Rigid video nasal endoscopy with playback
Septum ulcerated to the left samll active bleeding _(does it qualify for 31238?)_Inferior turbinates erythema , Nasopharynx no lesions or excessive mucous
Would you code this as 31231 or 31238

Also,

Turbinates Coblation
Nose was decongested with neosynephrine sprays followed by injection into each turbinate. Reflex wand 45 _(isn't this for turbinate resection)_ was inserted into each turbinate for 20 seconds per pass.
Is this 30801 or 30140?

Nasal cautery
Topical anestheisa applied with lidocaine and epinephrine. Epistaxis controlled using suction cautery, superficial elecrocautery of bleeding turbinates were performed, after local anesthesia with pontocaine/afrin. Pt tolerated well. 

Is this "nasal cautery" included in 30801, or I have to code from 30901-30905. It does not specify Anterior simple, complex or posterior initial or subsequent?

So, the overall codes.
Would you code 31231-51 and 30801??

Thanks a bunch for all your replies.


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## dmaec

lmartirosyan said:


> I am going to type exactly how it appears on the progress note.
> Nasal Endoscopy
> Rigid video nasal endoscopy with playback
> Septum ulcerated to the left samll active bleeding _(does it qualify for 31238?)_Inferior turbinates erythema , Nasopharynx no lesions or excessive mucous
> Would you code this as 31231 or 31238
> _
> this one to me, is a diagnostic 31231, I don't see in the above mentioned note where he cauterized the small active bleeding while in there, separate procedure in my opinion_
> 
> Also,
> 
> Turbinates Coblation
> Nose was decongested with neosynephrine sprays followed by injection into each turbinate. Reflex wand 45 _(isn't this for turbinate resection)_ was inserted into each turbinate for 20 seconds per pass.
> Is this 30801 or 30140?
> _this one to me, is a 30801 - again, I don't see "resection" of anything._
> 
> Nasal cautery
> Topical anestheisa applied with lidocaine and epinephrine. Epistaxis controlled using suction cautery, superficial elecrocautery of bleeding turbinates were performed, after local anesthesia with pontocaine/afrin. Pt tolerated well.
> _this one to me is,  still a 30801 due to the turbinates cautery - _
> 
> Is this "nasal cautery" included in 30801, _{I believe the above "nasal cautery" is a 30801 and wouldn't code the 3090x codes}_ or I have to code from 30901-30905. It does not specify Anterior simple, complex or posterior initial or subsequent?
> _30901-30905 are control of less serious nose bleeds/ 30905 for bleeding that is coming from the back of the nose/30906 for subsequent_
> 
> So, the overall codes.
> Would you code 31231-51 and 30801??
> _{the above is how I'd code it also}_
> Thanks a bunch for all your replies.


_{that's my opinion on the posted matter}_


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## HCCCoder

Thank you, thank you, thank you!
I appreciate your help. )))))


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## HCCCoder

Amit, 
I respect your opinion too. I am sorry, but I agree with Donna.
Sorry about that and thank you very much for your time.


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## HCCCoder

Hello all,
I just came across another one, that doctor does not specify if the nasal cautery was superficial (30801) or intramural (30802). This is how it appears:
Turbinate Coblation
Appropriate consent was obtained.
Nose was decongested with neosynephrine sprays. 
Followed by injection with lidocaine to each turbinate.
Reflex wand 45 was inserted into each turbinate.

Nasal Cautery- epistaxis controlled using silver nitrate sticks. The procedure was tolerated well. 

Would you code this scenario as 30801 or 30802?
Or maybe I should deny because of not having enough documentation (unfortunately, can't interact with the physician).
Does anybody know, what "silver nitrate stick" is about? When they use this, which procedure you can code 30801 or 30802?

Thanks a lot to all of those who will respond.
Lilit


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## mmsnyrobi

*How would you code turbinates coblation, superficial nasal cautery & nasal endoscopy*

In review of CPT Code 31238:
The physician uses and edoscope for a diagnostic evaluation of the bleeding nose. An endoscope has a rigid fiberoptic telescope that allows the physician both increased visualization and magnification of internal anatomy. Topical vasoconstrictive agens are applied to the nasal mucosa and nerve blocks with local anesethesia are performed. The endoscope is placed into the nose and a thorough inspection of the internal nasal structures is accomplished. Any bleeding sources are identified. Electrocautery instruments or laser are placed parallel to the endoscope and are used to stop internal nasal bleeding.


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