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Question: A patient had surgery on a septal deviation with a perforation of 1 cm. The surgeon elevated the mucosa around the perforation posteriorly and made an incision through the cartilaginous tissue, elevating the contralateral mucosa off from the cartilaginous region posteriorly. The surgeon then removed the perforated cartilaginous tissue posterior to the perforation, then removed and kept cartilage, straightening it and placing back to cover up the perforation in the perforation site. Finally, the surgeon used stitches to approximate the cartilage into place before closing the incision site with sutures as well.

Which code is best for the following procedure — 30520 or 30630?

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Answer: The procedure you describe would not be coded with 30630 (Repair nasal septal perforations). Code 30630 describes repairing a nasal perforation in the septum wall, either by taking a flap or a graft of cartilage and placing it over the perforation.

Code 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft), however, describes correction of a deviated septum, where the surgeon removes tissue or crooked cartilage from the interior of the nose before straightening or otherwise correcting the septum deviation.

In other words, 30520 involves removing nasal tissue or cartilage to correct the deviation, while 30630 involves adding tissue to repair a tear or hole in the septum. This means 30520 more closely describes the work you have outlined and is the code you would use in such a scenario.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC