Otolaryngology Coding Alert

Question: Our office gets denials from insurance companies stating that turbinate cautery code 30802 is incidental to septoplasty code 30520. Even after we appeal claims with letters explaining why the procedures are separate, payers still deny our claims. Is there a correct way to bill both of these codes for payment?

New York Subscriber

Answer: Commercial insurers' bundling software probably denies 30802 (Cautery and/or ablation, mucosa of turbinates, unilateral or bilateral, any method [separate procedure]; intramural) with 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) because CPT considers cauterization (30802) a separate procedure that is normally included in the primary procedure. You should separately report "separate procedure" codes when the otolaryngologist performs cauterization alone or when the septoplasty qualifies as a distinct procedural service (modifier -59, Distinct procedural service) from the primary procedure.

In your case, the primary procedure, septoplasty, occurs at a different site - the septum - from the turbinate cautery - the turbinate. Therefore, you should report the septoplasty (30520) and the cautery (30802) and append modifier -59 to 30802 to indicate a separate site from the primary procedure.

Having a separate diagnoses will help show that the internal cautery (30802) is not an integral component of the septoplasty (30520). For instance, if the otolaryn-gologist performs the septoplasty to treat a deviated septum (470, Deviated nasal septum) and destroys the internal mucosa at the same operative session for turbinate hypertrophy (478.0, Hypertrophy of nasal turbinates), you should report 30520, 30802-59. Link 30520 to 470, and 30802 to 478.0.

That being said, some payers may still deny the cauterization as incidental to the septoplasty. In such situations, continued appeals may not make financial sense. You may instead want to discuss with your otolaryngologists whether they want to continue to participate with these insurers.