Otolaryngology Coding Alert

Question: An insurer denies 30802 when we bill with 30520. I didn’t think the two procedures were bundled, so we’re planning to appeal. Are there certain things we should remember?

Connecticut Subscriber

Answer: You’re correct in thinking that 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) and 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]) normally are not bundled. Part of the problem is that both of these codes are often referred to as SMR (submucous resection), but each represents a different anatomic site resection.

In your appeal, refer to the operative note and indicate how 30520 is for treatment of the deviated septum and 30802 is for treating hypertrophied turbinates. These are two different sites in the nasal cavity and treatments were for two different reasons. Also point out that Correct Coding Initiative (CCI) edits do not bundle the codes so the billing should be allowed. Make sure your diagnosis codes are appropriately linked to the CPT^® codes as required to support the individual medical necessity.