Otolaryngology Coding Alert

Question: Payers deny septoplasty as inclusive to functional endoscopic sinus surgery (FESS). Is there anything I can do to get them to pay 30520?

California Subscriber

Answer: This bundling issue occurs because the insurer thinks that the otolaryngologist performed the

septoplasty to gain access to the sinus(es), rather than for a distinct reason.

You should appeal denials for 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) when the surgeon performs the septoplasty for a pathology unrelated to the reason for the sinus surgery and you have op notes that support this. To halt 30520 bundles, try these tips:

1. Train your surgeons to include a separate paragraph in the op report describing the repairs made to the nasal septum and why the septoplasty is medically necessary.

2. To further justify medical necessity for the septoplasty, use different diagnosis codes for the procedures. Example: A 42-year-old female with a deviated septum and chronic frontal sinusitis on CT scan undergoes bilateral, frontal sinus exploration with tissue removal and septoplasty. To support the septoplasty as medically necessary, link 31276-50 (Nasal/sinus endoscopy, surgical with frontal sinus exploration, with or without removal of tissue from frontal sinus; Bilateral procedure) to 473.1 (Chronic frontal sinusitis), and 30520-51 (Multiple procedures) to 470 (Deviated nasal septum).

3. Consider trying modifier 59 (Distinct procedural service) on 30520 to indicate that the septum is a separate site from the sinus. Because Medicare never bundles septoplasty with FESS, modifier 59 is necessary only when billing non-Medicare carriers.