Otolaryngology Coding Alert

Question: Our physician performed a right submucosal resection of the inferior turbinate. After incising the inferior turbinate, the physician elevates mucosa off the bone using a cottle. He then inserts a coblator to ablate the submucosal tissue from the inferior turbinate. After completion, the physician applies a Doyle Splint to outfracture the inferior turbinate. Would you opt to code this as 30802 and 30930, or solely as 30140?

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Answer: This one is tricky. Let’s compare these three procedures:

• 30140, Submucous resection inferior turbinate, partial or complete, any method 
• 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)  
• 30930, Fracture nasal inferior turbinate(s), therapeutic

On the surface, the correct code for this encounter might appear to be 30140. What adds some confusion to this question is the wording within the procedure description. The phrase “any method” seems to allow for the inclusion of ablation of the submucosal tissue as a means of reaching the outfracturing process — even though it’s not directly specified in the code description.

However, when we take a closer look at procedure 30140, we see that this procedure involves the complete removal of the bone submucosally, which was not documented here. “Because this was a coblation — which uses radiofrequency to reduce the size of the turbinate — this qualifies for 30802,” explains Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, AAPC Fellow, Vice President at Stark Coding & Consulting LLC, in Shrewsbury, New Jersey. “You cannot code 30930-59, as there is no justification for the 59 modifier. There is no separate site nor a separate encounter — so this is solely coded as 30802.”

Takeaway: As long as documentation of an incision exists, the use of code 30802 is appropriate. In this case, the documentation of a radiofrequency procedure (coblation) implies that an incision is made into the mucosa. Without documentation of an incision into the mucosa, you could technically apply 30801 (Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method …). If an FESS procedure was also involved, you would include modifier 59 (Distinct procedural service) on 30801 since the two procedures occur on separately identifiable anatomical sites.

Additional considerations: The 30802 code is inherently unilateral or bilateral — so you cannot apply modifier 50 to reflect the bilateral nature of the procedure.