Otolaryngology Coding Alert

Question: Our surgeon performed wide local excision of a nasoseptal lesion, with underlying cartilage and bone. He diagnosed low-grade adenocarcinoma. How should I code this?

Maine Subscriber

Answer: You have two codes to choose between for the excision of intranasal lesions, depending on the circumstances:

• 30117 – Excision or destruction (e.g., laser), intranasal lesion; internal approach
• 30118 – … external approach (lateral rhinotomy).

As you can see from the descriptors, the difference lies in the surgeon’s approach. For 30117, the surgeon places the surgical instruments into the nose to perform the procedure. For 30118, he creates a full thickness incision into the nose from the outside, to access the nose and cartilage to excise and/or destroy the intranasal lesion. There is a great deal more trauma to the skin and appearance of the patient with 30118 and often requires plastic repair. The plastic repair is not always performed during the encounter when the lesion is removed. Think whether the lesion was removed from the inside the nose or from outside the nose, cutting, to reach inside the nose.