Otolaryngology Coding Alert

Question: An otolaryngologist performs a septoplasty, submucous resection of inferior turbinates, and open reduction and internal fixation of nasal fracture. The surgeon states that he performed septoplasty for the cartilage. The nasal fracture reduction and fixation treated the severe deformity and the inability to breathe. How should we bill the procedures?

Louisiana Subscriber

Answer: You should report two of the three surgeries: the turbinate resection (30140, Submucous resection turbinate, partial or complete, any method) and the fracture treatment (21330, Open treatment of nasal fracture; complicated, with internal and/or external skeletal fixation).

Do not bill the septoplasty (30520, Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft). The National Correct Coding Initiative bundles the septoplasty (30520) with the nasal fracture treatment (21330). Medicare considers reshaping the nasal septum part of the fracture treatment.

No Medicare edits exist for the turbinate resection (30140) and the fracture treatment (21330). Coders, have, however, had problems with insurers bundling a turbinectomy with a septoplasty, which sometimes carries over to other nasal procedures.

Proper diagnostic coding will help avoid a denial. A payer that edits a fracture and turbinectomy may do so because the procedures both occur in the nose. Even so, the surgeon performs them on different anatomic sites - the septum and the nasal cavities.

You can help show the insurer that the operations are separate with different diagnoses. Because the nasal fracture repairs the deformity, link the nasal fracture treatment to the fracture diagnosis (such as 802.0, Nasal bones, closed). The turbinectomy treated turbinate hypertrophy (478.0, Hypertrophy of nasal turbinates).

If the payer denies the turbinectomy, consider refiling the claim with modifier 59 (Distinct procedural service) on the lesservalued procedure - the turbinectomy (30140 contains 9.97 relative value units compared to 15.65 for 21330). The modifier indicates that the turbinate is a separate site from the septum. Alternatively, report the turbinectomy as a multiple procedure (modifier 51) based on insurer rules.

Bottom line: Depending on insurer policy, possible combinations include:

• 21330, 30140 (to Medicare carriers that don't require 51)
• 21330, 30140-51 (to carriers and payers that do)
• 21330, 30140-59 (to insurers that bundle the turbinectomy).