Otolaryngology Coding Alert

Question: Should we report 30140 if the otolaryngologist performs turbinate Coblation? If so, what should we do when an insurer denies turbinate Coblation as investigational or bundles the procedure into other codes such as 30520, 31255-50-51, 31267-50-51, or 30140-50-51?

New York Subscriber
 
Answer: You should use 30802 (Cautery and/or ablation, mucosa of turbinates, unilateral or bilateral, any method [separate procedure]; intramural) -- not 30140 (Submucous resection turbinate, partial or complete, any method) -- if the physician performs turbinate Coblation.

Code 30140 states "submucous resection," so the otolaryngologist must remove all or part of the turbinate bone while leaving the mucosa if you want to report 30140. If he makes an incision into the mucosa and excises only the lateral mucosa but not the turbinate bone, you may append modifier -52 (Reduced services) to 30140 to indicate a turbinate reduction.

But Coblation doesn't involve incision or excision. During Coblation, the otolaryngologist uses radiofrequency (RF) energy to remove or shrink soft-tissue turbinate volume. You should report the electrical current destruction process as ablation (30801, ... superficial; or 30802). Because Coblation or RF ablation destroys the mucosa from within, you should report 30802.

You should also report the other procedures that the physician performed. The National Correct Coding Initiative doesn't bundle turbinate ablation with septoplasty (30520, Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft), total ethmoidectomy (31255, Nasal/sinus endoscopy, surgical; with ethmoidectomy, total [anterior and posterior]) or maxillectomy (31267, Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus).

If a payer denies 30802 as inclusive in the nasal or sinus codes, you should appeal with a copy of the latest NCCI edits. Explain that a bundle shouldn't exist because the turbinate procedure occurs at a separate anatomic area from the septum and sinus operations.

That said, some insurers may consider Coblation in-vestigational and medically unnecessary. Aetna and HGSA, for instance, won't cover Coblation, so you should always try to precertify the procedure. If your insurer tells you ahead of time that it will deny the claim, ask the patient to sign a waiver of liability. That way, if the payer denies the service, you can bill him directly.

Other experts recommend that you report 30999 (Unlisted procedure, nose) for turbinate Coblation.

Note: Visit the American Academy of Otolaryngology-Head and Neck Surgery's Web site for more information on coding RF ablation of the turbinate: http://www.entlink.net/practice/resources/radio_frequency.cfm.