Otolaryngology Coding Alert

One biller is now receiving fewer denials due to appeals letters A little effort can go a long way when it comes to payment for 31240 with 30140 or 30520. That's what one coder found. Take crib notes on what worked at his three-ENT practice. If you-re getting denials for 31240 (Nasal/sinus endoscopy, surgical; with concha bullosa resection), there are others in your boat. "An American Rhinology Society (ARS) member is having a problem with 31240 being bundled with 30140 (Submucous resection inferior turbinate, partial or complete, any method) or 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft)," says Michael Setzen, MD, FACS, FAAP, Clinical Associate Professor in Otolaryngology at NYU School of Medicine and Section Chief of Rhinology at North Shore University Hospital in Manhasset, N.Y. Tip 1: Stress That CCI Doesn't Bundle These Combos "Code 31240 can be reported separately from 30140 and/or 30520," says Ben Willis, billing manager at Accurate Medical Billing LLC in Tennessee. The Correct Coding Initiative (CCI) does not include 31240 with 30520, 30140 or 30130 (Excision inferior turbinate... ). "Concha bullosa resection (31240) is a separately identifiable service," Willis says. Insurers should reimburse it as such. Point out to payers that bundle these codes that CMS allows separate reimbursement for them. In the appeal letter, "Remind the insurer that the national guidelines do say that 31240 is separate and can be billed with these codes," Willis says. Tip 2: Encourage Solid 31240 Note Your otolaryngologist must clearly document the endoscopic resection of the middle turbinate's concha bullosa of the middle turbinate, coding experts say. Explain that describing all the work involved in the added procedure in the operative note will allow you to pinpoint the separate procedure and code for it appropriately. Benefit: You-ll be able to highlight the work that describes 31240. In the event of an appeal, solid 31240 documentation will go a long way in showing the insurer that the endoscopic concha bullosa resection is indeed a separately identifiable procedure. Tip 3: Indicate Separate Site With 59 Before appealing for 31240 payment, try this modifier tactic: "Send the initial claim out with a 59 modifier (Distinct procedural service) instead of a 51 (Multiple procedures)," Willis says. It's OK: If an insurer places an edit on the concha bullosa code, you can use modifier 59 to indicate 31240 occurs on a separate site. The otolaryngologist performs the endoscopic concha bullosa resection on a separate site (the middle turbinate) from the turbinectomy (30130, 30140, inferior) and the septoplasty (30520, the septum). Beware: Insurers may not have adjusted their system edits in the wake of CPT 2006's definition change for 30130 (Excision inferior turbinate, partial or [...]