Otolaryngology Coding Alert

Question: I billed out 30520 and 30930-51, and 30930 was denied, stating it is included with 30520. The payer said "Based on CPT Assistant December 2002 guidelines, fracturing of nasal turbinates (30930) is considered incidental and therefore included in septoplasty or surgical sinus endoscopies when reported together. If the provider performed 30930 on a distinct and separate anatomic location or during a distinct and separate patient encounter on the same date of service, an override modifier -59 may be reported."

I had already checked CCI edits, however, and had not found 30930 bundled with 30520. What should I do?

Pennsylvania Subscriber

Answer: Appeal the claim. Explain to the payer that the descriptor for 30930 (Fracture nasal inferior turbinate[s], therapeutic) was updated in 2006, four years after the publication of the CPT Assistant note that the payer is citing.

Change: In 2002, 30930 was "any turbinate." Now, the code is specific to the inferior turbinate only. Code 30930 was previously bundled because the fracture of the middle turbinate might be considered incidental to  the septoplasty, but the inferior turbinates are not incidental and are in a separate location.

Therefore, you may report 30930 separately with 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft). No modifier is needed.

However, if the payer remains unmoving with this argument, you may want to consider adding the 59 modifier (Distinct procedural service) to indicate that the turbinate being outfractured is a separate site from the middle turbinate. This is a last choice option.