# nasal septum surgery



## jocoffey (Apr 19, 2016)

Hi, I need help in coding an op note; these are the procedure codes md performed, 30520,20912,30465,30802,30930,14060-

A left sided hemitransfixion incision was made. Dissection was the performed in the submucoperichondrial and submucoperiosteal plane of the nasal septum.  On the left side, a 1cm crossover point was made  leaving a 1cm caudal and dorsal strut.  Dissection was performed on the right side as well.
The bony cartilaginous junction was separated, the cartilage dissected off the maxillary crest and the cartilage was removed en bloc.  Next, there was
a spur posteriorly.  This was resected using double-action scissors, and a spur along the floor of the nose was resected using 8mm osteotome.
The hemitransfixion incision was closed with 5-0 gut sutures and 4-0 plain gut on a keith needle was used to appose the mucosal flaps.
Attention was turned tot he repair of the nasal vestibular valve stenosis. A left sided rim incision and a right-sided alar rim incision was made and
dissection was the performed medially and laterally along both alar rim pockets.
Attention was turned to separately on the Mayo stand where 2 separate alar rim grafts were created, beveled medially and laterally on both sides.
the 1st alar rim graft was slid into the alar rim and closed using 5-0 sutures.  On the right similarly, the 1st alar rim graft was slid into the pocket and closed using sutures.
Attention was turned to the left sided redundant skin in the vestibule bilaterally.  Elliptical incision was made of redundant skin.  This left a defect.
A 7x8 mm advancement flap was used to close the defect with formal back cuts.  This was closed with fast gut sutures.  In addition, the right hand
side similarly as portion of skin was excised with elliptical incision. Formal cuts were created to form an advancement flap 7x8mm.  This was closed
with sutures.  This constituted the adjacent tissue rearrangement on the right and left of the nasal vestibules.
Next, attention was turned to the turbinates where the Colorado tip needle was inserted into the anterior head of the inferior turbinate. Visible shrinkage
was noted. In addition the right side similarly the needle was inserted into the inferior turbinate and visible shrinkage of turbinate was noted.
Next boises elevator was inserted into the left hand side of the nasal cavity posteriorly to anteriorly. The inferior turbinate was outfractured, and the right hand side similarly was outfractured.
Is 30520 bundled with 20912, also is 30802 bundled with 30930?  Also is it appropriate to bill 14060 bilaterally?  I need verification and clarification.
thanks to anyone, who can help.


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## ltrue (Apr 19, 2016)

*Per AAPC*

14060  


Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less

CCI Validation Results:

No CCI edit; Check CPT® coding guidelines to make sure code is allowed.



30520  


Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft

CCI Validation Results:

No CCI edit; Check CPT® coding guidelines to make sure code is allowed.


20912  


Cartilage graft; nasal septum

CCI Validation Results:

No CCI edit; Check CPT® coding guidelines to make sure code is allowed.


30802  


Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tiss ...

CCI Validation Results:

*Code 30802 is a column 2 code for 30930 , but a modifier is allowed in order to differentiate between the services provided.
*Use modifier with code 30802
CCI edit Rule:
Standards of medical / surgical practice*


Note*: Always use modifier (if allowable) with column 2 code. 

The current NCCI-associated modifiers are: E1, E2, E3, E4, FA, F1, F2, F3, F4, F5, F6, F7, F8, F9, LC, LD, LM, RC, RI, LT, RT, TA, T1, T2, T3, T4, T5, T6, T7, T8, T9, XE, XP, XS, XU, 24, 25, 27, 57, 58, 59, 78, 79, and 91. Read about modifiers for CPT and  HCPCS  codes 


30930  


Fracture nasal inferior turbinate(s), therapeutic

CCI Validation Results:

No CCI edit; Check CPT® coding guidelines to make sure code is allowed.


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## marcos226 (Jun 19, 2016)

*30520*

provider is billing 31276-51 with 30520 as procedure is being done thru endoscopy...is this billable. as I was under the impression 30520 can be done thru endoscopy and no additional code needed. need help...


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