Otolaryngology Coding Alert

Question: An operative report describes a performed procedure as "open reduction of nasal fracture with septoplasty." The note also indicates "Dissection was done between the mesial curara down to the caudal margin of the septum" and "Curved guarded osteotomies were used to close the open reduction by infracturing the nasal bones on either side." The surgeon billed 30520 and 30400.

Georgia Subscriber

Answer: You are correct in choosing a nasal fracture code (21325-21336) instead of rhinoplasty codes (30400, Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip; or 30420, - including major septal work). Use 21325-21336 when the surgeon truly treats a fracture, not a late fracture as with functional rhinoplasty.

As far as the fracture code goes, recommend to the surgeon the appropriate code using the given documentation and on these guidelines:

Minimally, the surgery is 21330 (Open treatment of nasal fracture; complicated, with internal and/or external skeletal fixation). Assuming that the patient had a nasal fracture, the otolaryngologist did an open reduction of a nasal fracture, which 21330 represents.

If the primary procedure is the open reduction and the surgeon also provided and clearly documented septum treatment, you would use 21335 (Open treatment of nasal septal fracture; with concomitant open treatment of fractured septum). Septum work seems probable from the last sentence of the operative report that you mention above. The last sentence indicates the otolaryngologist used curved guarded cuts to reshape the nasal septum.

If the patient had a fractured septum that the surgeon treated, the appropriate code is 21336 (Open treatment of nasal septal fracture, with or without stabilization).

Catch this: The Correct Coding Initiative bundles an open reduction of a nasal fracture (21325-21335) into septoplasty (30520, Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft). Since the intent of the surgery was a fracture repair and the diagnosis supports a fracture repair, bill the fracture repair and not the septoplasty. If you bill the septoplasty, the carrier will pay it only.