Otolaryngology Coding Alert

A picture's worth a thousand words -- and might just be the clincher in endoscopic concha bullosa resection pay.

Can you blame your claim adjudicator for not being able to conjure a mental picture of the septum and inferior and middle turbinates? Stop her from getting sweaty palms trying to figure out why 31240 (Nasal/sinus endoscopy, surgical; with concha bullosa resection) deserves separate payment from 30140 (Submucous resection inferior turbinate, partial or complete, any method) and 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) with this portrait and easy-to-comprehend form letter.

Dear [Name of claims adjudicator]:

This letter is to appeal your denial of payment for the attached claim.

You denied our claim for services rendered to our patient by erroneously bundling endoscopic concha bullosa resection CPT code 31240 (Nasal/sinus endoscopy, surgical; with concha bullosa resection) with inferior turbinate code 30140 (Submucous resection inferior turbinate, partial or complete, any method) and/or septoplasty code 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft). You allowed no payment for 31240.

You indicate that CPT code 31240 for endoscopic concha bullosa resection should be bundled with the other procedures provided rather than being billed separately.

However, CPT coding guidelines do allow for a separate charge in this instance. We have confirmed this with the Correct Coding Initiative version 14.0, effective Jan. 1, 2008, and consulted CPT Coding Guidelines as provided by the American Medical Association.

The surgeon performs the endoscopic concha bullosa resection as a distinct, separate procedural service from turbinectomy and/or septoplasty. The concha bullosa occurs on a separate site (in the middle turbinate) from the turbinectomy (inferior turbinate) and/or the septoplasty (the septum). Code 30140 no longer refers to just "turbinate." CPT 2006 revised 30140's definition to describe only the inferior turbinate, which does not overlap with a concha bullosa's location, the middle turbinate. "When a middle turbinate becomes pneumatized, or filled with air, the term concha bullosa is applied," says the American Academy of Otolaryngology -quot; Head and Neck Surgery.

As you can see from the following drawing, the surgeon performs these procedures on separate anatomic sites. I have submitted 31240 with modifier 59 (Distinct procedural service) to indicate separate sites.