Don’t Inflate This Balloon-Dilation Septoplasty Claim
Question: What is the correct way to report an in-office septoplasty by balloon dilation? My physician insists on billing 30520, possibly using modifier 52. However, I disagree and believe it should be an unlisted code. AAPC Forum Participant Answer: Coding 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) with or without modifier 52 (Reduced services) would not be the correct way to report a balloon-dilation septoplasty. That’s because the septoplasty procedure described by 30520 involves the trimming, repositioning, or replacing (with grafts) of cartilage and/or bone, which the provider achieves through a series of incisions within the nose. However, rather than reconstructing the deviated septum through a series of incisions, in a balloon-dilation septoplasty, the provider realigns the septum using a balloon dilation microfracture technique. Since the septoplasty with balloon dilation involves a distinctly different approach, involving no incisions, your only option is to submit this service using the unlisted nasal procedure code 30999 (Unlisted procedure, nose). For billing purposes, as with all unlisted procedure codes, you will want to include a reference code for your payer. This enables them to value the unlisted procedure correctly. In the case of balloon-dilation septoplasty, the most appropriate code to use would be 31295 (Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); maxillary sinus ostium, transnasal or via canine fossa). Note: If the surgeon opts to use a balloon in addition to making incisions into the bone and/or cartilage, you’ll bill 30520 instead of the unlisted code, as the code includes the tissue removal or excision into the maxillary, frontal, or sphenoid sinuses. Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
