Follow These 3 Steps for Precise Nasal Lesion Removal
Question: What is the correct way to bill for the removal of nasal lesions on both sides of the patient’s septum? Revenue Cycle Insider Subscriber Answer: There are several steps to negotiate before assigning the proper coding to this scenario. First, you need to determine whether your provider’s approach was internal or external. Internal lesion removals are coded with 30117 (Excision or destruction (eg, laser), intranasal lesion; internal approach); code external removals with 30118 (… external approach (lateral rhinotomy)). Second, per CPT® guidelines, as the nose is regarded as a midline structure (a structure located on the vertical line that symmetrically separates the right side of the body from the left), you will need to use the RT (Right side) and LT (Left side) modifiers rather than modifier 50 (Bilateral procedure) (see CPT® Assistant, Volume 29, Issue 11, November 2019). Third, Medicare has assigned a Medically Unlikely Edit (MUE) of “1” to both codes, meaning that you can only use the code once per date of service (DOS). As a result of the MUE, you will need a modifier to justify being paid for the provider performing the procedure on both sides of the patient’s nose. Depending on payer preference, that modifier could be XS (Separate structure …) or 59 (Distinct procedural service). Putting it all together: Assuming the provider performed the lesion removal internally, and you are billing Medicare or a payer following Medicare rules, you would code 30117-RT, 30117-XS-LT for the removal of nasal lesions on both sides of the patient’s septum. Other payers may require different reporting, especially regarding two-sided procedures that cannot be coded with modifier 50. So, it is important to check payer policy before submitting your nasal lesion removal claims this way. Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
