Otolaryngology Coding Alert

Question: My otolaryngologist performed 30410 and harvested a septal graft for the reconstruction. I'm thinking an additional septal graft code should go with the rhinoplasty code. Am I right?

Montana Subscriber

Answer: Yes. CPT code 30410 (Rhinoplasty, primary; complete, external parts including bony pyramid, lateral and alar cartilages, and/or elevation of nasal tip) does not include the harvest of the septal graft because the graft is obtained through a separate surgical incision. If your otolaryngologist's documentation mentions the harvest of the septal graft, you may report 20912 (Cartilage graft; nasal septum). Append modifier 51 (Multiple procedures) to 20912 as this is the lesser valued procedure.

You can report the graft harvest separately because the physician did not perform any work on the septum in the situation you describe, such as a septoplasty. However, if your otolaryngologist had performed a septorhinoplasty, then you could not have reported the septal graft.

Tip: You use primary rhinoplasty codes for a patient's first nasal surgery. Otherwise, a secondary rhinoplasty applies (30430, Rhinoplasty, secondary; minor revision [small amount of nasal tip work]; 30435, ... intermediate revision [bony work with osteotomies]; or 30450, ... major revision [nasal tip work and osteotomies]).