Otolaryngology Coding Alert

For otolaryngologists, the introduction of 30465 (repair of nasal vestibular stenosis [e.g., spreader grafting, lateral nasal wall reconstruction]; 21.58 RVUs) may be the most welcome news in CPT 2001 because it describes a clearly functional procedure that previously had to be billed using a rhinoplasty code.

The operation is performed to improve the breathing of patients who have nasal stenosis (scarring or contracture, which causes an internal narrowing of the nasal valve), often as a result of prior surgery. To effect the repair, the otolaryngologist may revise the tip, floor and soft tissue of the nose. In addition, a graft must be obtained and placed.

This code has been needed for a long time, says Lee Eisenberg, MD, an otolaryngologist in private practice in Englewood, N.J., and a member of CPTs editorial panel and executive committee. Carriers previously classified this procedure as cosmetic, but the introduction of the code will help clarify that the repair is functional.

Gaining payment for the procedure may still require additional effort, Eisenberg warns, because some carriers may confuse the procedure with rhinoplasty: 30465 appears in the same section of CPT as the rhinoplasty codes and directly follows those codes.

Some carriers, furthermore, have yet to enter the new code in their computer software, and otolaryngologists have reported being asked by their Medicare carriers to resubmit their claims using the old (rhinoplasty) codes until the software is updated.

Note: As with rhinoplasty, 30465 does not include obtaining a graft. This service is separately payable, and CPT instructs otolaryngologists to see codes 20900-20926 and 21210. Coders should also note that 30465 describes a bilateral procedure. If only one side is repaired, modifier -52 (reduced services) should be appended.

Because the code describing this procedure is both new and easy for carriers to associate with rhinoplasty, contact your carrier in advance for a predetermination of benefits in writing. Make sure the carrier understands in advance that the procedure is functional and that appearance is a secondary consideration, Eisenberg advises. For example, specify that the repair is being performed on a patient who underwent prior nasal surgery and now has interior nasal stenosis. As a result, additional tissue [a graft] needs to be placed to open the airway and allow the patient to breathe properly.

As with rhinoplasties, the appropriate ICD-9 code should be linked to the procedure, and documentation should include a findings section that explains why the repair was medically necessary.