Otolaryngology Coding Alert

Question: Claims for bilateral turbinate resections performed in our office have been denied twice by our state Medicare carrier. We billed both claims 30140, 30140-50. Can we bill for bilateral resection of turbinates?

Alabama Subscriber

Answer: The claims may have been rejected because they were filed on two lines, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding and reimbursement specialist and educator in North Augusta, S.C. Although private carriers may want to see bilateral procedures billed this way, most Medicare carriers instruct providers to bill only once. In this case, the procedure should have been billed 30140-50 (submucous resection turbinate, partial or complete, any method-bilateral procedure).

Increasingly, however, some payers including local Medicare carriers are paying bilateral turbinate resection and reductions at 100 percent only, instead of 150 percent. These carriers claim that the procedure is paid the same whether unilateral or bilateral and that therefore additional reimbursement is not warranted.

The basis for these claims, however, cannot be found in any authoritative coding manual or publication, and coding specialists are urging otolaryngologists to appeal these rejections because they are inappropriate.

In an appeal letter drafted to address a recent nonpayment for bilateral turbinate reduction, Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions in Lakewood, N.J., notes that the descriptors for CPT codes 30130 (excision turbinate, partial or complete, any method) and 30140 refer to a singular turbinate, and that the Health Care Financing Administrations (HCFA) national physician fee schedule valued the procedures on the basis of their being unilateral. The fee schedule also indicates that both procedures can be appended with modifier -50. Medicodes Coders Desk Reference and the American Medical Associations Code Manager also state that turbinates can be billed with modifier -50 and reimbursed at 150 percent of the fee schedule.

Turbinate reduction is often performed in conjunction with other procedures, such as ethmoidectomies or septo-plasties, and carriers also frequently deny turbinate reduction procedures when performed at the same time as these other procedures. The nonpayment of bilateral turbinate claims, however, does not appear to be related to these equally inappropriate denials, Cobuzzi says.

Cobuzzi recommends writing a letter appealing the inappropriate denial. The letter should point out that:

All authoritative references, including Medicares own fee schedule, directly address the issue of bilateral turbinate resection and indicate modifier -50 is correctly used and the procedure should be paid at 150 percent.

Medicare carriers are not allowed to change the Medicare fee schedule and the premises under which RVUs have been established.

The CPT description of both 30140 and 30130 does not refer to unilateral or bilateral turbinates, but rather uses the singular (turbinate), which indicates that if performed bilaterally, the code requires modification.

By violating the HCFA fee schedule, the carrier is not in compliance with its own mandate.

The letter should also inform the carrier of your intention to use HCFAs appeal process to pursue this matter before a fair hearing and, if necessary, before an administrative law judge.