Otolaryngology Coding Alert

Coblation points you to 30801-30802

You can take the mystery out of coding for radio frequency ablation (RFA) of the turbinates -- just look for these key words and the destruction site.

Don't Let These Terms Mask Ablation

Hunting for -RF- in an op note can be tricky. CPT doesn't contain codes that specifically state -radio frequency- or -RF- -- but codes for this service do exist. Other terms that indicate RFA include:

- coblation, which is an -approach to removing tissue surgically using low-heat electrosurgical equipment,- according to Put an End to Snoring's glossary.

Specifically, -coblation is shrinking the tissue via radiofrequency waves,- says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.

- reduction, as in radiofrequency tissue reduction (RFTR), which End to Snoring defines as an -approach to shrinking tissue (such as excess throat tissue or the uvula) using radiofrequency signals to heat a thin needle inserted in the tissue.-

-Reduce- (Webster-s) can also mean to make smaller, says John Fink, MD, an otolaryngologist at Dearborn Ear, Nose and Throat in Michigan. When doing RF to the turbinate, the surgeon hopes/plans to make the turbinate smaller -by causing submucosal scarring therefore -reducing- the volume of the turbinate.- The reduction causes more intranasal space and hopefully less restriction to the air passage.

"Other terms we use are -ablation- or -somnoplasty- in addition to radiofrequency,- adds Julie Keene, CPC, an otolaryngology coding and reimbursement specialist at University ENT Specialists in Cincinnati.

Use 30801-30802 for RFA of Inf Turbinate

When an otolaryngologist uses radio frequency to shrink inferior turbinate tissue, you should use inferior turbinate ablation codes. Assign either one of these:

- 30801 -- Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral, any method; superficial

- 30802 -- ... intramural.

Choose 30801 or 30802 based on the mucosa the otolaryngologist ablates using RF. -CPT code 30802 is intramural ablation or cauterization of the deeper mucosa, whereas 30801 is superficial ablation or cauterization, which involves only the outer layer of the mucosa,- say Richard Waguespack, MD, AMA CPT Panelist and Chair, CPT & Relative Value CMTE; and Charles F. Koopmann Jr., MD, the AAO-HNS Coordinator for Practice Affairs in -How Should I Code for Radio Frequency Ablation Techniques?- available at www.entlink.net/practice/resources/radio_frequency.cfm.

Realize Coblation = Destruction

You should think -destruction code- as soon as you see -coblation.- Coblation of the inferior turbinates points you to 30801-30802, not to excision code 30140 (Submucous resection inferior turbinate, partial or complete, any method).

Example: Coblation treatment of the nasal septal body done with bilateral submucous resection of inferior turbinates. Dx is nasal obstruction.

Answer: 30802. The -coblation treatment- should direct you to an inferior turbinate ablation code (30801-30802). Because the inferior turbinate ablation involved the submucous or deeper mucosa, you should use 30802.

Zooming in on -submucous resection of inferior turbinates- can incorrectly steer you to 30140-52. But when the surgery involves coblation or any other form of radio frequency, the surgical resection code (30140) is inappropriate. Documentation that indicates a submucous resection with coblation means coblation using radiofrequency, not an excision or resection, Cobuzzi says.

Similarly, if the surgeon uses -reduction- in an RF op note, you could accidentally fall for 30140. The parenthetical instruction following 30140 says, -For reduction of turbinates, use 30140 with modifier 52 (Reduced services).-

Report Other Turbinate With 30999

The AAO/HNS specifically states: -Use CPT code 30999 to report cautery or ablation of the middle or superior turbinates.- -I use the unlisted-procedure code 30999 for [radiofrequency of] the middle or superior turbinates,- Keene says.