Otolaryngology Coding Alert

Follow these steps to ensure your unlisted code gets paid.

Being a seasoned otolaryngology coder means you’ve come to expect an operative report for a given surgery to fall within a certain set of confines and parameters. When a surgical report hits your desk that breaks from the traditional mold, your work as a coder can become exponentially more challenging.

These sentiments have been shared by coders in otolaryngology practices whose physicians have begun to incorporate balloon inflation devices into septoplasty procedures. As you’ll see, the use of these devices fundamentally changes the makeup of both the procedure and the coding methodology.

Read further to get the correct handle on the coding methods for septoplasty procedures involving balloon dilation.

Distinguish Between Septoplasties With, Without Incisions

Before getting into any coding considerations, you’ve got to know how exactly a septoplasty with balloon dilation differs from a traditional septoplasty. While the end goal of each procedure amounts to a reconstruction of a deviated septum, the route in which the physician achieves this varies significantly between procedures.

A traditional septoplasty, as described in code 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft), involves the trimming, repositioning, or replacing (with grafts) of cartilage and/or bone. The physician achieves this through a series of incisions within the nose.

Keep in mind: “Code 30520 is described as being performed with or without cartilage scoring, but my experience has found that a resection of the cartilage occurs more often than not in addition the excision of the bone,” explains Kimberly Quinlan, CPC, senior medical records coder for the University of Rochester Medical Center’s Department of Otolaryngology in Rochester, New York.

Compare and Contrast Operative Reports

Consider this portion of an operative report for a traditional septoplasty:

• “A swivel knife was used to excise the deviated portion of quadrangular cartilage. Next, forceps were used to separate the superior and inferior portions of the bony septum posteriorly. Lastly, deviated portions were removed from the maxillary crest using a 4 mm osteotome.”

As you might expect, when you throw a balloon inflation device into the mix, the fundamentals of the surgery change dramatically. That’s in part due to the less invasive nature of a septoplasty with balloon dilation versus a traditional septoplasty. Rather than reconstructing the deviated septum through a series of incisions, the provider realigns the septum using a balloon dilation microfracture technique. Consider this portion of an operative report:

• “The septoplasty was performed by using the Acclarent RELIEVA TRACT™ Nasal Balloon Dilation System, which was sequentially inserted along the floor of the nose on both sides. The balloon was inflated which medialized the septum by microfrac­turing the quadrangle cartilage.”

Code Each Service With Confidence

Given the fundamentally distinct surgical techniques, you can understand why the coding mechanics will vary depending on which route your surgeon goes. If you’re operative note aligns with a traditional septoplasty, the coding process is as simple as reporting code 30520. Be sure to note that this code has a bilateral surgery indicator of “0,” meaning that the 150 percent payment adjustment does not apply. Therefore, you will not report modifiers LT (Left Side), RT (Right Side), or 50 (Bilateral Procedure) since the concept of laterality does not apply to the nasal septum.

The coding mechanics become much more complicated for the septoplasty with balloon dilation. In order to report code 30520, an incision into the septal mucosa and subsequent resection of the bone and/or cartilage of the septum must occur. Since the septoplasty with balloon dilation involves a distinctly different approach, involving no incisions, your only option is to submit this service using unlisted code 30999 (Unlisted procedure, nose).

The last piece in the coding puzzle is determining what existing code is most similar to the septoplasty with balloon dilation. Submitting an existing reference code alongside an unlisted code is important for contextual purposes. “It is recommended that you report a comparison code of 31295 [Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); maxillary sinus ostium, transnasal or via canine fossa] if the surgeon uses one balloon,” advises Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO, of CRN Healthcare in Tinton Falls, New Jersey. “If the surgeon uses two balloons, you should also equate 30999 to 31295, except with modifier 50 appended,” says Cobuzzi.

To consider: If the surgeon opts to use a balloon in addition to making incisions into the bone and/or cartilage, bill 30520 instead of the unlisted code. Similar to balloon sinus dilation surgeries that also include tissue removal or excision into the maxillary, frontal, or sphenoid sinuses, you’ll report the appropriate functional endoscopic sinus surgery (FESS) code instead of a balloon sinus dilation code.