Otolaryngology Coding Alert

Question: In an operative report, the otolaryngologist describes performing a septoplasty and nasal stenosis repair. May I report the septoplasty in addition to the nasal stenosis repair?

Utah Subscriber

Answer: The answer depends on the payer and your policies. Some practices adopt uniform coding standards while others code per insurer.

Medicare: When filing claims involving 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) and 30465 (Repair of nasal vestibular stenoisis [e.g., spreader grafting, lateral nasal wall reconstruction]) to a Medicare carrier or payer that follows the Correct Coding Initiative (CCI), you should report only 30465. CCI bundles 30520 (septoplasty) into 30465 (nasal stenosis repair) with a modifier indicator of "0", meaning the edits permit no unbundling.

Non-Medicare: If documentation supports separate reasons with separate ICD-9 codes (470, Deviated nasal septum and 478.19, Other diseases of nasal cavity and sinuses) for the procedures, you may report both 30520 and 30465 to third-party payers that do not adhere to CCI edits.