Otolaryngology Coding Alert

Question: Blue Cross Blue Shield is denying payment for 30802 when billed with 30465 because of medical necessity. We included diagnosis 478.0, which BCBS denied as experimental and investigational. We’ve billed this with no problems in the past. Can you advise us on what might have changed?  

Illinois Subscriber 

Answer: This could be due to many reasons.  First, the insurance company could be assuming that the surgeon performed radiofrequency (RF) shrinkage of the turbinates, which is included in the definition of 30802 (Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method [e.g., electrocautery, radiofrequency ablation, or tissue volume reduction]; intramural [i.e., submucosal]). The payer might be saying that radiofrequency is experimental, but RF coblation of turbinates has been around for more than ten years. If this is the case, appeal the denial with supporting documentation and diagnosis 478.0 (Hypertrophy of nasal turbinates). 

Also remember that 30802 may not necessarily represent radiofrequency – you can also report 30802 for cautery. Find out what the op notes say and address that in the appeal. Coding edits do not bundle 30802 and 30465 (Repair of nasal vestibular stenosis [e.g., spreader grafting, lateral nasal wall reconstruction]). If you have demonstrated medical necessity, your physician should be paid.