Otolaryngology Coding Alert

Question: I have a physician who wants to bill both 30140 and 30930 during the same surgical session. He had our clerk bill both these on several claims and insurances have paid both. My feeling is we should not be billing for both the submucosal resection and outfracture. When I look at 30930, there is no Correct Coding Initiative edit for billing with 30140, but if you look at 30140, the CCI edit is there for 30930. Can you explain why we should or should not bill these together?

Minnesota Subscriber

Answer: If bone is outfractured but not removed and submucosal tissue is removed, you would append modifier 52 (Reduced services) to 30140 (Submucous resection inferior turbinate, partial or complete, any method); that code would properly describe reduction of turbinates.

To bill 30140, the mucosa must be incised, and the bone cut out and removed from the mucosa, leaving the mucosa behind. Excising the bone and mucosa qualifies for 30130 (Excision inferior turbinate, partial or complete, any method). Neither applies to coblation or any other names for radiofrequency ablation, which should be 30802 (Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral, any method; intramural) or, if on the middle or superior turbinates, 30999 (Unlisted procedure, nose).

When your ENT performs inferior-turbinate procedures on a single side, you may code only the most extensive procedure. You must not code multiple turbinate procedures on the inferior turbinate at the same time. You can, however, bill a turbinate procedure on one side and a different procedure on the other side.

-- Answers to You Be the Coder and Reader Questions provided/reviewed by Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J.