Otolaryngology Coding Alert

You might face denial next time you use 30801 and a FESS code.

If you thought the CPT 2006 redefinition of 30801 made it safe to use when also coding a FESS procedure, the Correct Coding Initiative (CCI) has bad news for you.

CCI's latest edits, effective Jan. 1, bundle turbinate "coblation" code 30801 (Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral, any method; superficial) into several codes, including 31200 (Ethmoidectomy; intranasal, anterior) and 31287 (Nasal/sinus endoscopy, surgical, with sphenoidotomy). Both 30801 and 30802 (Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral, any method; intramural) are bundled into 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) and 31238 (Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage).

The context: Private carriers have long tried to bundle 30801 and 30802 with functional endoscopic sinus surgery (FESS) codes such as 31235 (Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy [via puncture of sphenoidal face or cannulation of ostium]). "Carriers use software that automatically bundles these codes with FESS," warned ENToday in August 2006. "Your claim may be denied based on same incision or gaining access."

The CCI editors feel that doctors were using 30801 and 30802 to describe ways to gain access for the endoscope to sinus passages, or to control bleeding associated with an endoscopy, says R. Waguespack, MD, the chair of American Academy of Otolaryngology-Head and Neck Surgery's (AAO-HNS) CPT & Relative Value Committee.

The committee disagrees. "The typical use of these codes for turbinate reduction associated with hypertrophic rhinitis and airway obstruction was explained to-NCCI decision-makers, especially with regard to 30802," Waguespack says.

When your ENT performs a sinus endoscopy, he must pass the middle turbinates on his way to the ethmoids and the maxillary sinuses -- for instance, to perform the procedures described by 31254 (Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial [anterior]) or 31267 (Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus).

The inferior turbinates, however, do not provide access for these procedures. In the 2006 CPT Manual, the AMA redefined 30801 and 30802 (as well as 30930, 30130, and 30140) to refer only to the inferior turbinates to avoid these denials. Now, carriers have a new tool in their denial toolbox.

However, it shouldn't hurt too badly, Waguespack suggests. "Edits of 30801-with nasal/sinus surgeries should have relatively little impact on otolaryngologists, as most are reasonable or can be reported with the 59 modifier [Distinct procedural service]," he says. "Further, it is our understanding that 30802 would be the more typically reported service."

Three sets of turbinate pairs in the nose (superior, middle, and inferior) secrete mucous, which provides humidity and keeps the inside of the nose clean. Swollen turbinates (478.0, Hypertrophy of nasal turbinates) may obstruct breathing. ENTs perform several procedures, including those that 30801 and 30802 describe, to alleviate this swelling -- alone or, more often, with other procedures, such as FESS and septoplasty.

30801/30802: These codes describe electrocautery or ablation of the turbinate mucosa to shrink enlarged tissues. No incision or excision is performed. The code 30801 describes a superficial, or external, cauterization on the surface of the mucosa, whereas 30802 describes the destruction of the mucosa from within.

If your ENT performs these procedures with an unrelated service, you should append modifier 59 to 30801 or 30802 to show that the turbinate shrinkage is not bundled with the other procedure.

Here's how: According to CMS instruction, you should append modifier 59 to "the secondary, additional, or lesser procedure(s) or service(s)" -- in this case, 30801 -- to indicate that you performed two separate procedures.

The CCI edit table has a "modifier indicator" column. If the codes you-re trying to report together have an indicator of "1" next to them, you may be able to append modifier 59 to bypass the edit, says Maggie M. Mac, CMM, CPC, CMSCS, CCP, ICCE, consulting manager for Pershing, Yoakley and Associates in Clearwater, Fla. If the code has a "0" indicator, you cannot bypass the edit under any circumstances. The CCI edits change quarterly, so be sure to keep abreast of all updates.

An example of proper modifier 59 use would be when the turbinate is shrunk on one side of the nose and the other procedure is performed on the other side. Modifier 59 is appropriate as these two procedures are performed on separate sites.