Otolaryngology Coding Alert

Otolaryngologists in growing numbers are reporting that when they bill for a septoplasty (30520, septoplasty, or submucous resection, with or without cartilage scoring, contouring or replacement with graft) performed during the same session as 30140 (submucous resection of turbinate, partial or complete, any method), the 30140 is being denied. If proper documentation is submitted to the carrier, both codes should be paid. These denials are inappropriate and should be appealed vigorously, coding specialists say.

Otolaryngologists and coding specialists agree there is no medical justification for bundling the two procedures. They are performed on different anatomical sites, the only common characteristic being that they both take place somewhere in the nose. And whereas the septum is made of cartilage, turbinates are bony projections. A septoplasty is performed to correct a deviated nasal septum that causes nasal obstruction, while resection of turbinates is done for turbinate hypertrophy (478.0) which also contributes to nasal obstruction.

The roof, septum and turbinates are three distinct, separate parts of the nose, says Gretchen Segado, MS, CPC, assistant compliance manager at Thomas Jefferson University in Philadelphia, citing the American Academy of OtolaryngologistsHead and Neck Surgeons (AAO-HNS).

Still, the denials continue to roll in, and without any published edits available, coding specialists are left to speculate as to why these procedures have been bundled.

One theory, which has been borne out by the experience of at least one provider, is that both codes contain the words submucous resection. Consequently, some carrier representatives are confusing the procedures.

Note: Just below the descriptor for septoplasty, 30520, the CPT manual clearly states: for submucous resection of turbinates, use 30140.

Confusing Similar but Distinct Procedures

Lee Eisenberg, MD, an otolaryngologist in Englewood, N.J., and a member of CPTs executive committee and editorial panel, says that ClaimCheck, a code editing software used by insurance carriers, reportedly had a panel of experts determine that turbinate surgery is a component of septoplasty, which he says is ridiculous.

Segado speculates that some carriers may consider the procedures inclusive because the indications for both are similar. Because a septoplasty typically is performed to correct a deformity in the partition between both sides of the nose, and turbinectomy is the removal of an abnormally enlarged turbinate, Both procedures are performed to improve breathing, Segado says, adding that this does not in any way mean the procedures should be bundled.

There also are continuing difficulties relating to inappropriate bundling of septoplasty and sinus endoscopy and bundles of turbinate procedures with nasal endoscopy, so it is conceivable that carrier coders are confusing similar but entirely distinct procedures and issuing inappropriate denials.

In addition, Segado notes that if the otolaryngologist performs septoplasty, endoscopic sinus surgery and turbinate resection, the middle [...]