Otolaryngology Coding Alert

" The various CPT codes involving turbinate procedures are not always easily differentiated. If the otolaryngologist fails to indicate clearly what he or she does, there is no way for the coder to know which code to select. Additionally, there are coding guidelines not found in the national Correct Coding Initiative (CCI) that apply when reporting these procedures. Failure to follow these guidelines almost always results in denials.

There are three sets of turbinate pairs in the nose (superior, inferior and middle) that secrete mucous, providing humidity and keeping the inside of the nose clean. They can swell or shrink, thereby affecting the size of the nasal passages. Turbinates that are hypertrophied (enlarged or overgrown due to an increase in the size of constituent cells) contribute to nasal obstruction. Various procedures are performed to alleviate this condition, either alone or, more often, with other procedures, such as functional endoscopic sinus surgery (FESS) and septoplasty (When the septum is deviated to one side, the inferior turbinate on the other side often may enlarge and block the nasal cavity).

To reduce the size of or remove one or more turbinates, otolaryngologists may perform:
  Excision  Resection  Reduction  Ablation  Cauterization  Outfracturing  Endoscopic excision or resection.
 CPT lists six codes for these procedures, including:
  30130 -- excision turbinate, partial or complete, any method; 6.96 relative value units (RVUs)
30140 -- submucous resection turbinate, partial or complete, any method; 7.81 RVUs
30801 -- cauterization and/or ablation, mucosa of turbinates, unilateral or bilateral, any method, (separate procedure); superficial; 2.89 RVUs
30802 -- ... intramural; 4.49 RVUs
30930 -- fracture nasal turbinate[s], therapeutic; 3.11 RVUs
31240 -- nasal/sinus endoscopy, surgical; with concha bullosa resection; 4.75 RVUs 

(Dorland's Medical Dictionary defines the concha bullosa as a cystic distension of the middle nasal concha" " which is another term for the middle turbinate).

Understand Terminology To Select the Proper Code
30130/30140/30140-52: When describing turbinate procedures many otolaryngologists use the words "resection" and "excision" interchangeably. But because 30130 describes an excision and 30140 is used to report a submucous resection the precise definition of these and other terms associated with turbinate procedures needs to be understood.

Code 30130 describes the excision of all or part of the turbinate usually the inferior turbinate says Lee Eisenberg MD an otolaryngologist in private practice in Englewood N.J. and a member of CPT's editorial panel and executive committee. 

" Code 30130 should be reported when the otolaryngologist does not make an incision into the mucosa to resect the turbinate but rather goes in and excises mucosa and bone at the same time " Eisenberg says. He adds that in theory such an excision could also apply to the middle turbinates except when any ethmoid sinus surgery is performed on the same side.

A submucous resection is [...]