Otolaryngology Coding Alert

Plus, know what role RFA may play in excisions.

Making the proper distinctions between one type of surgical procedure versus another isn't always a cakewalk. This is especially true for surgical procedures which, by the end of the operation, achieve similar end goals. For example, consider surgical treatments for hypertrophy of the turbinates. It's the coder's job to maneuver through the operative report lingo to differentiate between a turbinate reduction, resection, and excision.

That's only the beginning, though. You've also got to make sure you can properly interpret some tricky phrasing within the code descriptions, as well.

Keep reading for a complete breakdown of all the how-to's behind turbinate reduction, resection, and excision coding.

Identify Superficial Versus Intramural Ablation Procedures

In order to identify the correct surgical code within the operative report, you must have a clear understanding of what the turbinate destruction and surgical excision codes entail. For instance, take a look at these two destruction codes:

• 30801 - Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); superficial
• 30802 - Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); intramural (ie, submucosal)

In these procedures, the provider might utilize a radiofrequency ablation (RFA) technique to "destroy," or ablate, the soft tissue of the inferior turbinates. However, as you can see, these codes are differentiated by the superficial versus intramural descriptors. According to the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS), code 30801 "involves only the surface layer of the inferior turbinate mucosa." On the other hand, code 30802 "is the ablation or cauterization of the deeper mucosal soft tissue."

In respect to differentiating these procedures, the AAO-HNS explains that "from the perspective of physician work, RFA in these clinical situations does not differ significantly from the use of uni- or bi-polar electrocautery. Thus, CPT^® guidelines require each of these methods of cautery/ablation to be reported in the same fashion, just as one would with tonsillectomies performed by various methods (eg, electrocautery, laser, dissection with surgical instruments)."

Recognize Difference Between RFA, Surgical Excision

As opposed to RFA techniques designed to reduce or "destroy" the inferior turbinate, the surgical excision option does just that - either fully or partially removes the inferior turbinate via a surgical excision technique. Consider the following two codes:

• 30130 - Excision inferior turbinate, partial or complete, any method
• 30140 - Submucous resection inferior turbinate, partial or complete, any method

"I like to think of 30130/30140 as an 'old-fashioned' incision with a scalpel, removal of inferior turbinates, and with 30140, preservation of the mucosa. Whereas 30801/30802 being the 'newer' techniques of ablation, coblation, radiofrequency, etc., destroys mucosa/submucosa to access the inferior turbinates to remove or shrink them," explains Jennifer M. Connell, CPC, COC, CENTC, CPCO, CPMA, CPPM, CPC-P, CPB, CPC-I, CEMA, owner of E2E Health Solutions in Victoria, Texas.

There are also a few important differences between the surgical excision codes. First, it's important to explain the differences and similarities between an excision and a submucous resection. For the sake of accurate coding, you should understand that the underlying difference between these terms is simply a matter of semantics, above all else. That is, the end goal for both procedures is a partial or complete removal of the inferior turbinate. The fundamental difference between these procedures comes down to whether or not the surgeon preserves the mucosa in the surgical process.

If the surgeon documents an excision of both the mucosa and inferior turbinate in the operative note, you immediately know that you should use code 30130. However, if the surgeon makes a submucosal incision, preserving the mucosa, in order to partially or completely remove the inferior turbinate, you will rely on code 30140.

"Think of 30130 as cutting a branch off a tree with a saw - the bark and branch are all sawed through and the branch is removed, says Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO, AAPC Fellow, vice president at Stark Coding & Consulting LLC, in Shrewsbury, New Jersey. "Whereas with 30140, picture the woodsman opening up the bark and cutting the branch out, leaving the bark still dangling from the tree," Cobuzzi explains.

Know RFA's Role in Turbinate Excisions

In some examples, the surgeon might document the use of a RFA technique, such as a coblator, during the process of surgically excising the inferior turbinate. In these examples, coders may have an especially difficult time identifying the correct CPT^® code.

The first point you have to consider is the extent to which the surgeon uses the RFA device in the procedure. For example, the AAO-HNS states that "only if the RF device were used to incise mucosa and resect submucosal soft tissue and/or bone, should CPT^® 30140 be reported."

However, keep in mind that a scenario in which the provider uses an RFA device as the underlying instrument to incise the mucosa and resect the submucosal tissue and/or bone is extremely unlikely to take place. More often than not, the provider may incise the mucosal tissue in order to perform an RFA on the turbinate bone. This would qualify as an intramural RFA, which you will code as 30802.