# Removal of nasal septum neoplasm



## azukixx

I'm having a hard time finding a code for a removal of a malignant neoplasm of the nasal septum.  The physician coded it as 30117, but I think that is completely wrong. Help?


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## FTessaBartels

*Why?*

Why do think 30117 is wrong?

Can you post the op note?

F Tessa Bartels, CPC, CEMC


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## azukixx

Op Report:

I used a zero-degree endoscope to further evaluate the mass of the nose.  It extended all the way from the anterior nasal cavity to the nasopharynx.  I could not tell for certain whether this was arising from the lateral sinus wall or the nasal septum.  I took several generous biopsies of this, which were taken to pathology, and confirmed squamous cell carcinoma.  In light of this, I turned my attention to the definitive resection.  I initially utilized a microdebrider to debulk the majority of the tumor and it became obvious that the tumor was originating from the nasal septum rather than the lateral nasal wall or the paranasal sinuses.  It was located approximately 2 cm from the posterior aspect of the septum and extended all the way to the sphenoid face.  there was a through-and-through defect with tumor extending into the right nasal cavity, once again involving just the septum, however.  I inspected through the right nasal cavity, confirm the position of the tumor here as well.  I debulked both sides to facilitate exposure.  I then made my initial incision anterior to the anterior edge of the tumor stalk, allowing a grossly negative margin of about 1 cm.  This was carried through-and-through the nasal septum down to the floor of the nose.  I then came across the inferior aspect of the nasal septum.  There was approximately a 5- to 6-mm space between the inferior portion of the tumor and the nasal floor.  I made my mucosal incision in this area bilaterally.  Finally, I turned my attention superiorly.  There was a fairly clear margin of normal mucosa at the superior aspect of the septum.  I cut across this area using Double Action forceps, taking the septum up to the level of the skull base.  Finally with this performed, I was able to fracture through the posterior aspect of the septum at the face of the sphenoid and remove the specimen.  It was sent for pathology as a permanent section.  

After that he does a sphenoidotomy, ethmoidectomy and antrostomy on the second page of the report. 
I didn't feel that 30117 fit because the description to me limits the lesion excision to cryo, laser, or chemical destruction, and he's not doing any of that.


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## FTessaBartels

*30520?*

*Not *my area of expertise, but have you considered 30520?  The approved Dx include various malignancies of nasal cavities or respiratory system. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## blonde01

azukixx said:


> Op Report:
> 
> I used a zero-degree endoscope to further evaluate the mass of the nose.  It extended all the way from the anterior nasal cavity to the nasopharynx.  I could not tell for certain whether this was arising from the lateral sinus wall or the nasal septum.  I took several generous biopsies of this, which were taken to pathology, and confirmed squamous cell carcinoma.  In light of this, I turned my attention to the definitive resection.  I initially utilized a microdebrider to debulk the majority of the tumor and it became obvious that the tumor was originating from the nasal septum rather than the lateral nasal wall or the paranasal sinuses.  It was located approximately 2 cm from the posterior aspect of the septum and extended all the way to the sphenoid face.  there was a through-and-through defect with tumor extending into the right nasal cavity, once again involving just the septum, however.  I inspected through the right nasal cavity, confirm the position of the tumor here as well.  I debulked both sides to facilitate exposure.  I then made my initial incision anterior to the anterior edge of the tumor stalk, allowing a grossly negative margin of about 1 cm.  This was carried through-and-through the nasal septum down to the floor of the nose.  I then came across the inferior aspect of the nasal septum.  There was approximately a 5- to 6-mm space between the inferior portion of the tumor and the nasal floor.  I made my mucosal incision in this area bilaterally.  Finally, I turned my attention superiorly.  There was a fairly clear margin of normal mucosa at the superior aspect of the septum.  I cut across this area using Double Action forceps, taking the septum up to the level of the skull base.  Finally with this performed, I was able to fracture through the posterior aspect of the septum at the face of the sphenoid and remove the specimen.  It was sent for pathology as a permanent section.
> 
> After that he does a sphenoidotomy, ethmoidectomy and antrostomy on the second page of the report.
> I didn't feel that 30117 fit because the description to me limits the lesion excision to cryo, laser, or chemical destruction, and he's not doing any of that.



Did you ever find an answer to this?  I have a similar operative note with a septectomy with removal of a portion of the midline hard palate with the microdebrider drill and then removal of septum all the way up to the skull base where a midline portion of the anterior skull base/anterior cranial fossa was excised.  He is coding 61600 and 30520.  I know that 61600 is incorrect (no brainer) but I'm not sure whether it should be unlisted (64999) or included in the septectomy (if 30520 IS in fact correct) and I'm not sure how to include the soft tissue removal from within the incisive foramen (hard palate).  All of this was performed transnasal via endoscope.  ANY help with this would be GREATLY appreciated!!


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## kvangoor

How about 31640?


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## blonde01

kvangoor said:


> How about 31640?



Neither one of these describe that a bronchoscopy was performed so 31640 will not work.


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