Otolaryngology Coding Alert

Question: I-m having trouble with 31240 being bundled with 31255. Do you have any suggestions?

New York Subscriber

Answer: You can separately bill endoscopic resection of concha bullosa of the middle turbinate (31240, Nasal/sinus endoscopy, surgical; with concha bullosa resection) that the otolaryngologist performs in addition to ethmoidectomy (31254-31255, Nasal/sinus endoscopy, surgical; with ethmoidectomy ...).

Ethmoidectomy codes do not include the work value for concha bullosa resection (31240), according to David W. Kennedy, MD, FACS, who was involved with the initial AMA relative value update committee valuation of the functional endoscopic sinus surgery (FESS) CPT codes. Some third-party bundling software, however, does bundle any form of turbinectomy (including inferior turbinectomy) with ethmoidectomy. You should appeal bundles with two pieces of ammunition:

Your part: Tell your otolaryngologists that solid documentation can make the difference between 31240 payment on appeal and nonpayment. The surgeon should document the endoscopic excision of the concha bullosa well. The operative note should show all the work involved in the added procedure.

Support: Submit a copy of Kennedy's article explaining why 31240 is separately payable. "Appropriate resection of a concha bullosa, with preservation of middle turbinate integrity, and preservation of the mucosa on both sides of the preserved lamella, and resection of areas of exposed bone does indeed create a significant time commitment," he counters in "Should Excision of Concha Bullosa Be Reimbursed in Addition to That for Endoscopic Surgery?" published by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). Download a copy of the article from http://www.codingandreimbursement.net/downloads/Concha_Bullosa-Dr_Kennedy.pdf.

Expect the payer to subject 31240 to multiple- procedure payment reduction rules, reducing payment by 50 percent when it's billed as a second procedure. Code 31240 has 4.35 transitional facility total relative value units (RVUs) or pays about an additional $87.