Otolaryngology Coding Alert

Question: We submitted a claim with codes 21325 and 30520. The insurer denied 21325, but we aren’t sure why. Can you explain?

Indiana Subscriber

Answer: Nasal fracture treatment codes such as 21325 (Open treatment of nasal fracture; uncomplicated) should be used when the physician treats an acute fracture, not an old or healed fracture. The rhinoplasty codes such as 30420 (Rhinoplasty, primary; including major septal repair) are more appropriate when treating a healed fracture.

FYI: Many providers tend to want to stick with 21325 even with old or healed fractures because they are concerned about not getting paid for functional (non-cosmetic) rhinoplasty services (30420) from third party payers. The claim may not get paid initially and require an appeal to show the payer that the service was for a functional problem and was not cosmetic, but that should not prevent the provider from using the correct coding.

CCI edits list 21325 as a Column 2 code of 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft), meaning that 21325 is bundled into 30520. You are not allowed to “break the bundling edit” with a modifier and bill the two procedures together. Instead, you only report 30520 as the more extensive procedure.