Otolaryngology Coding Alert

Question: I am trying to understand the reasoning behind bundling 30801 with 31240. My scenario is this: Surgeon performed 31240 on the left and 30801 bilaterally; 30801 was completed in order to reduce hypertrophic inferior turbinates (not for cauterization of other procedures done on the same day). He completed 31240 on the left to remove the concha bullosa causing nasal obstruction. We billed 31240-LT (which was paid) and 30801-59 (which was denied as bundled). What is your suggestion?

North Carolina Subscriber

Answer: As long as your documentation clearly supports the procedures, then you should appeal. Many insurers like to bundle 31240 (Nasal/sinus endoscopy, surgical; with concha bullosa resection) into another service or bundle other services into it.

Clearly outline in your appeal letter that the surgeon performed 31240 on the middle turbinate and 30801 (Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method [e.g., electrocautery, radiofrequency ablation, or tissue volume reduction]; superficial) on the inferior turbinate. You can go further to explain that 31240 is a unilateral code and does not include the RVUs for 30801 performed on the right side.

Include copies of the pages from the CPT® manual as well as a copy of the NCCI edit showing that CPT® 30801 is payable with 31240 when documentation supports the use of modifier 59 (Distinct procedural service).

In your appeal letter, stress that the inferior turbinates are separate anatomic structures from the middle turbinate (where the concha bullosa was located). So, although they both include “turbinates”, 30801 involves the inferior turbinate and the 31240 involved the concha bullosa located by the middle turbinate. This denial may be a throw-back to when 30801 used to include “any” turbinate, but you can inform the payer that the definition changed in 2006 to include only the inferior turbinate.