Otolaryngology Coding Alert

Consider this important update to last month's article.

Last month, you were briefed on the coding process and surgical techniques behind the new LATERA absorbable nasal implant procedure. We would like to follow up on this article with a few clarifications regarding the manufacturer's stance on its suggested method of coding.

In last month's article, you were advised to code the Latera procedure using the unlisted code 30999 (Unlisted procedure, nose) rather than with 30465 (Repair of nasal vestibular stenosis [eg, spreader grafting, lateral nasal wall reconstruction]). We incorrectly stated that the manufacturer's suggestions were to code using 30465; however, this has not been the case since the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS) recently came out with a revised coding suggestion of 30999, a change from their previous suggestion of 30465 noted in the 2010 AAO-HNS Clinical Consensus Statement on the Diagnosis and Management of Nasal Valve Compromise.

For complete transparency, please read the following statement from Entellus Medical, the manufacturer behind the LATERA absorbable nasal implant procedure:

• "The recently published article providing guidance on billing for the repair of nasal valve stenosis using the LATERA implant did not accurately portray the manufacturer's position with respect to coding for the implants. At the time of the product's release, Spirox, now owned by Entellus Medical, was advised by external legal counsel, independent coding experts, and key opinion leaders that 30465 was appropriate to use when billing for the LATERA implant. These experts stated that the code was not restricted to the repair technique and that over time, a variety of techniques with varying costs have been billed using that code. These experts were primarily informed by the 2010 AAO-HNS Clinical Consensus Statement on the Diagnosis and Management of Nasal Valve Compromise, which clarified that 30465 may be used for a variety of procedures for the repair of nasal vestibular stenosis."

"We appreciate the AAO-HNS' support for the use of LATERA as a safe and effective treatment for nasal valve collapse," explains Martha Christian, VP of Reimbursement at Entellus Medical. "We are working closely with the AAO-HNS to address questions and concerns from physicians and facilities, all in the interest of preserving patient access to treatment with LATERA."

Disclaimer: If your provider uses equipment and techniques that have no dedicated CPT^® codes, you may be able to enlist the manufacturer's aid to receive appropriate reimbursement. Manufacturers often maintain free information and helplines to advise physician practices on how to approach insurers regarding new technologies or procedures.

Sometimes manufacturers' representatives will have helpful documentation about the equipment or technique that you could use as a second resource, but don't rely on them to assist you with the coding aspect of the service. Always check with your payer to determine its preferred coding.