Otolaryngology Coding Alert

Plus: Here’s how to handle middle turbinate coding.

The nose has three turbinates (inferior, middle and superior) on each side to clean and humidify air as it moves through the nose into the lungs. Turbinate procedures are common in otolaryngology practices, so follow our guide keep your inferior turbinate claims on track.

Checkpoint 1: Get to Know the Correct Codes and Laterality

CPT^® 2016 includes five codes for inferior turbinate procedures only. They are:

• 30801 – Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (e.g., electrocautery, radiofrequency ablation, or tissue volume reduction); superficial
• 30802 – … intramural (i.e., submucosal)
• 30130 – Excision inferior turbinate, partial or complete, any method
• 30140 – Submucous resection inferior turbinate, partial or complete, any method
• 30930 – Fracture nasal inferior turbinate(s), therapeutic.

Details in your provider’s notes will help point you toward some codes versus others. For example, incising and entering the turbinate mucosa and removing some of the bone while keeping the mucosa in place supports 30140 (look for details about the mucosa being entered/incised and preserved and the surgeon removing bone and/or tissue). A statement such as, “Excised the turbinate” doesn’t include enough details about the procedure to support 30140. You would need to report 30130 instead, which would cost your practice about $60 (30130 is valued at 10.90 RVUs, or $390.27 based on the 2016 national conversion factor of 35.8043; 30140 carries 12.62 RVUs or a value of $451.85) because 30130 includes cutting out the turbinate bone and mucosa together without any preservation of the mucosa.

Tip: One way to look at 30140 is to picture taking the bone out of the mucosa as one would take a banana out of the peel, keeping the peel in place and intact.

Also pay attention to CPT^® and other coding guidelines. The descriptors for 30801 and 30802 specify “unilateral or bilateral,” so it’s easy to know that you cannot append modifier 50 (Bilateral procedure) for bilateral treatment. But don’t miss that the outfracture code, 30930, on the other hand is only a unilateral code. The Medicare fee schedule specifically allows modifier 50 for 30930 when it is performed bilaterally. Its RVUs are based on the outfracturing one side only.

In addition to 30930, codes 30130 and 30140 are also both unilateral. You can include modifier 50 on these claims, assuming you have clear documentation that the inferior turbinates were resected on both sides or submucously resected on both sides. If the inferior turbinate on one side (right) is resected (30130) and the inferior turbinate on the other side (left) is resected submucously, 30140, the services would be coded 30140-LT and 30130-59-RT (or for Medicare 30130-XS-RT).

Other restrictions for reporting codes together also apply. See the chart on page 35 as a handy reference for these guidelines.

Be careful: Some providers refer to radiofrequency reduction or ablation of inferior or middle turbinates as “submucous resection of turbinates.” This would incline a coder to select 30140. However, that code choice is incorrect because the radiofrequency procedures are not radiofrequency submucous resections, they are radiofrequency shrinkage of the turbinates. This means that these procedures are appropriately coded as 30802 when performed on the inferior turbinates and 30999 (Unlisted nasal procedure) when performed on the middle turbinates.

Checkpoint 2: Brush Up on Terminology

Being familiar with medical terminology will help you better understand what your surgeon does. Here’s what you need to remember for turbinate procedures:

• Resection is the act of cutting something out (30140)
• Submucous means that the mucousa is entered and preserved
• Ablation is removing or destroying the function of a structure (30801 and 30802)
• Cautery is an agent or device used for scarring or burning the anatomic structure by applying heat, cold, electric current, or caustic chemicals.

Checkpoint 3: Be Cautious With Multiple Procedures

Your surgeon might perform multiple turbinate procedures during an encounter, but that doesn’t mean you file for each one.

Key: Do not bill multiple turbinate procedures on the same side of the inferior turbinate for payment. Only bill for the most extensive procedure completed on each side.

Example: CCI edits consider 30801 to be a Column 2 code for 30930 (Fracture nasal inferior turbinate[s], therapeutic). Unlike some edit pairs that allow you include a modifier to “break” the bundle, you cannot bill these services together under any circumstances.

Middle turbinate difference: The turbinate CPT^® codes used to indicate “any turbinate” and therefore both the middle and inferior turbinates once fell under all of the above codes. But in 2006, CPT^® changed the wording for all the turbinate codes to include only inferior turbinates, which resulted in no codes addressing middle turbinate procedures. This is usually not much of an issue since middle turbinate procedures are bundled with FESS surgeries. But at times, middle turbinate procedures are performed with just a septoplasty. In that case, there is no bundling issue and the middle turbinate procedure code should be reported separately. After the definition changes in 2006, the resultant option for coding middle turbinate procedures is only the unlisted nasal code, 30999, no matter what the surgeon does (cautery, excision, outfracture, or submucous resection). Equate the unlisted code to the equivalent inferior turbinate service.