Otolaryngology Coding Alert

Question: Insurance companies are bundling inferior turbinate resection and lateralization of turbinate procedures (30140, 30930) with the septoplasty procedure (30520) and paying only the septoplasty code. Is there another way to code these procedures to show that they are separate and distinct procedures?

                                                                                                                               Georgia Subscriber

Answer: Unfortunately, you are not the only one receiving denials for claims involving same-session septoplasty and inferior turbinate procedures, such as 30140 (Submucous resection turbinate, partial or complete, any method) and 30930 (Fracture nasal turbinate[s], therapeutic). Although the Correct Coding Initiative does not edit these procedures, many payers may erroneously bundle them.

No medical justification exists for bundling the two procedures. They are performed on different anatomic sites; the only characteristic that they share is they both occur in the nose. Although both procedures improve breathing, they are performed for different reasons. A septoplasty is performed to correct a deviated nasal septum, while resection of turbinates is done for turbinate hypertrophy (478.0).

In addition to fighting denials that a turbinectomy is incidental to a septoplasty, you may have to argue that the septoplasty was performed for medical reasons, rather than cosmetic reasons.

When you receive a denial, first check the diagnoses that you entered on the CMS 1500 claim form. Make sure that you are properly crosslinking the specific diagnosis code to the associated procedure. The diagnoses code(s) that you entered in section 21 are numbered from 1 to 4. The number representing the correct ICD-9 code must correspond to the associated procedure code in section 24E.

For example, an otolaryngologist performs a turbinate resection and septoplasty in the same operative session on a patient who has a deviated nasal septum (470) and hypertrophy of the nasal turbinates (478.0).

To correctly link the diagnoses codes with the appropriate procedures, report 470 in field 1 of section 21, and 478.0 in field 2. List the septoplasty procedure (30520) at the top of section 24D. Next to it, in section 24E, a "1" should be entered to represent the deviated nasal septum diagnosis. List the turbinate resection (30140) below the septoplasty, with diagnosis "2" (hypertrophy) entered in the box to the right (section 24E). Only if this is done are the codes properly crosslinked.

Next, if you did not use modifier -59 (Distinct procedural service) on your claim, consider using the modifier on the inferior turbinate to indicate a separate site from the septoplasty. See "Four Distinct Scenarios Shine Light on Modifier -59" on page 76.

Basic convention indicates that you do not bill multiple turbinates. You should bill only one of the turbinate procedures (30140 or 30930) with the septoplasty. The resection (30140) has a higher relative value (8.25 relative value units [RVUs]) than the fracture (30930, 3.52 RVUs), so report the resection only, as shown above. Doctors have been known to get in trouble for billing multiple turbinates.