Otolaryngology Coding Alert

Question: I have a doctor that performed a “placement of bilateral Latera implants for vestibular stenosis.” Should I bill this as 30465 or should I bill it using the new HCPCS code C9749?

Mississippi Subscriber

Answer: In answering this question, you should refer to a previous article titled “Learn the Coding Fundamentals Behind this New Nasal Implant Procedure” in Otolaryngology Coding Alert Volume 20, Number 1. In this article, we discuss how the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS) advises that this procedure be coded as 30999 (Unlisted procedure, nose), not 30465 (Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal wall reconstruction)). This coding suggestion applies to physicians billing under the Medicare Physician Fee Schedule (MPFS).

However, when billing under the Outpatient Prospective Payment System (OPPS), in a facility such as an Ambulatory Surgery Center (ASC) or hospital outpatient operating room (OR), the facility may report HCPCS code C9749 (Repair of nasal vestibular lateral wall stenosis with implant(s)) when your provider performs the placement of a Latera implant for vestibular stenosis. So, assuming you are coding for a physician billing under the MPFS, the facility should not consider C9749 and the provider should continue to report 30999.