Otolaryngology Coding Alert

Discover the new codes to use for PNN destruction in lieu of 30999.

Ablation therapy is an alternative to medical management for patients with refractory rhinitis, and utilization of this minimally invasive technology is on the rise. Most otolaryngology coders have come across charts describing ablations for treating chronic rhinitis and had time to refine their coding practices. What you might not be familiar with, though, are the recently released code updates and their impact on how to report these procedures.

Check out these four fast facts to ensure you’re up on the latest in coding ablation treatments for chronic rhinitis.

ENTs Perform 2 Primary Procedures To Treat Rhinitis

Ablative treatment of chronic rhinitis typically involves the use of cryoablation or radiofrequency ablation to destroy the posterior nasal nerve (PNN). Targeting specific regions of the PNN balances the autonomic input to the nasal mucosa, reducing the nasal antigen response and improving rhinitis symptoms such as congestion and rhinorrhea.

The two primary procedures otolaryngologists use for neurolysis of the PNN employ the following devices:

• RhinAer^®: This temperature-controlled radiofrequency (TCRF) device enables surgeons to target and eliminate soft tissue in the posterior nasal region using low-temperature radiofrequency (RF) energy. Keep in mind, ENTs can employ the RhinAer stylus for a more comprehensive treatment of the nasal passageway, which may involve the destruction of nasal swell bodies (NSBs) and/or ablation of the inferior turbinates (ITs) to reduce hypertrophy and open the airway.
• ClariFix^®: This cryoablation device uses nitrous oxide to freeze the nasal tissue, prompting nerve damage to the end of the PNN, which is necessary to control rhinitis.

Don’t miss: As of Jan. 1, 2024, you now have two Category I CPT^® codes available to report PNN destruction for treatment of chronic rhinitis: 31242 (Nasal/sinus endoscopy, surgical; with destruction by radiofrequency ablation, posterior nasal nerve) for RhinAer and 31243 (Nasal/sinus endoscopy, surgical; with destruction by cryoablation, posterior nasal nerve) for ClariFix. Use these new CPT^® codes in place of 30999 (Unlisted procedure, nose) when your provider performs PNN ablation.

Op Report Details Should Drive Code Selection

When submitting a claim for ablation therapy, “code selection should be based on the services documented by the provider in the procedure note, rather than coding based on the device used or what the payer tells you to use,” says Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO, CMCS, of CRN Healthcare Solutions of Tinton Falls, New Jersey. Proper reporting depends on the technique.

PNN destruction: When your otolaryngologist disrupts the PNN using RF ablation, report 31242, and for cases where cryoablation is employed, submit 31243. Primary diagnosis code options for PNN destruction include J31.0 (Chronic rhinitis), J30.0 (Vasomotor rhinitis), J30.1 (Allergic rhinitis due to pollen), or J34.89 (Other specified disorders of nose and nasal sinuses). You may use R09.82 (Postnasal drip) as a secondary diagnosis, as applicable.

IT ablation: Otolaryngologists may use RF ablation to destroy inferior turbinate soft tissue in the treatment of nasal obstruction due to IT hypertrophy. For these cases, you’ll use 30801 (Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); superficial) or 30802 (… intramural (ie, submucosal)). “Both codes are billed without modifiers for bilateral [B/L] procedures. Report 30802 or 30801 with ICD-10 code J34.3 (Hypertrophy of nasal turbinates) on the claim,” Cobuzzi notes.

Keep in mind: “TCRF may be billed comprehensively,” Cobuzzi adds. For example, when a patient with chronic rhinitis and nasal congestion undergoes treatment of both conditions — PNN and NSB destruction using the RhinAer stylus — you can continue to bill 30117 (Excision or destruction (eg, laser), intranasal lesion; internal approach) for the NSB destruction alongside 31242. Report 30117 with R09.81 (Nasal congestion). If treatment also involves IT ablation to treat hypertrophy, you may include 30802 or 30801.

“The newly assigned CPT^® codes for chronic rhinitis treatment may enhance coverage and reimbursement. If the payer deems the procedure ‘investigational’ or ‘experimental,’ despite proven efficacy over five years on tens of thousands of patients, the practice should reach out to the device company’s market access/reimbursement support department for assistance with appeals for payment,” according to Cobuzzi.

Don’t Use -50 With 30117 for B/L NSB Destruction

The Medicare Physician Fee Schedule (MPFS) and AMA CPT^® guidance do not permit billing 30117 as a bilateral code. So, when the provider destroys NSBs in both the left and right nostrils, you should report the code twice, “with the second occurrence of 30117 modified with an XS [Separate structure …] modifier or modifier 59 [Distinct procedural service] if the payer does not process the X{ESPU} modifiers,” Cobuzzi says.

The Medically Unlikely Edit (MUE) assigned to 30117 in the MPFS database is “2,” allowing submission up to two times in a single day when medically necessary, and the documentation supports this. “Destroying NSBs in the left nostril counts as one occurrence of 30117, even with the destruction of multiple swell bodies in that nostril. The second occurrence of 30117 is when the surgeon enters the contralateral nostril and destroys the NSBs in that nostril,” Cobuzzi explains.

Bottom line: The key to correctly coding B/L NSB destruction is to avoid using modifier 50 (Bilateral procedure) and instead submit -XS or -59 with 30117, depending on payer preference.

Planning Ahead Facilitates Proper Payment

If your otolaryngologist plans to use any of these ablation procedures for chronic rhinitis, contact the payer ahead of time to determine their reimbursement criteria and review what your contract with the payer allows your practice for reimbursement policies. Doing so is crucial, as payment for these rhinitis treatments can vary.

Stay tuned. We’ll dive deeper into chronic rhinitis ablation therapy payer policies and ways to strengthen your case for reimbursement next month.