Otolaryngology Coding Alert

Unlisted code 42299 remains your only option for LAUP.

Radiofrequency ablation (RFA) of the turbinates may be the procedure of choice for some physicians, but one continuing concern remains for many ENT practices: "How should I code for radiofrequency ablation techniques for turbinates, for the palate (UPPP), and for the tongue base?" These 3-point ideas let you in on the lowdown: But first, an important reminder: Radiofrequency devices have two main purposes. Physicians may use them to ablate tissue or as actual cutting tools (e.g., for tonsillectomy). You should select CPT®s based on the precise manner that your physician used the device.

1. Turn To 41530 For RFA, Base Of Tongue

You could look at reporting 41530 (Submucosal ablation of the tongue base, radiofrequency, one or more sites, per session) if your otolaryngologist treats OSA. This CPT® replaced 0088T (Submucosal radiofrequency tissue volume reduction of tongue base, one or more sites, per session [i.e., for treatment of obstructive sleep apnea syndrome]) in 2009. ICD-9 327.23 (Obstructive sleep apnea) and at least one of the following secondary codes (529.8, Other specified conditions of the tongue or 750.15, Macroglossia) are the only covered diagnoses for 41530. Make sure these codes are present in your claim, and must be documented in the medical record.

2. Laser-Assisted Uvulopalatoplasty Belongs To 42299 Alone

For RFA of the palate, uvula, you should use 42299 (Unlisted procedure, palate, uvula). CPT® guidelines maintain that no other CPT® code fits appropriately to describe RFA of the palate or uvula, and debunk the option of using the uvulopalatopharyngoplasty code 42145 (Palatopharyngoplasty [e.g., uvulopalatopharyngoplasty, uvulopharyngoplasty]) appended by modifier 52 (Reduced services). You cannot use 42145 (or 42145-52) because this code represents an excisional removal of the uvula and palate, and the laser ablation (or reduction in size) does not meet the guidelines for an excisional removal as necessary for 42145. Additionally, CMS has indicated that they do not consider a LAUP or a RFA of the uvula or palate standards of care and consider them experimental. The only way a payer can differentiate a LAUP and RFA of the palate and uvula is by using the unlisted code and disallowing the excisional code, 42145, for these alternative methods of getting the palate and/or the uvula out of the way of the airway.

Furthermore, you should not confuse laser-assisted uvulopalatoplasty (LAUP), which you should also report with 42299, with uvulopalatopharyngoplasty.

Rationalization: An outpatient treatment for snoring and mild forms of sleep apnea, LAUP (42299) involves a laser which the physician uses to vaporize part of the uvula, a small triangular piece of tissue that hangs from the soft palate above the back of the tongue. On the other hand, uvulopalatopharyngoplasty (42145) involves removing the uvula (and sometimes the tonsils), trimming the soft palate, and suturing all cut edges together. Physicians perform this surgical operation under general anesthesia in a hospital setting.

3. RFA Of Inferior Turbinates: 30801 For Surface Layer; 30802 For Intramural Soft Tissue

You should consider the precise nature of the procedure when coding RFA of the inferior turbinates. For instance, 30802 (Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method [e.g., electrocautery, radiofrequency ablation, or tissue volume reduction]; intramural [i.e., submucosal]) describes the ablation or cauterization of the deeper mucosal soft tissue, while 30801 (... superficial) pertains to the ablation or cauterization involving only the surface layer of the mucosa.

If the physician used a RF device to reduce the mucosa and another tool, such as a microdebrider to resect submucosal soft tissue and/or bone, you would report 30130 (Excision of inferior turbinate partial or complete, any method) or 30140 (Submucous resection inferior turbinate, partial or complete, any method) depending if the excision was a straight excision or if it was a submucous resection (i.e., enter the mucosa, resect the bone, preserving the mucosa, removing the turbinate bone from the remaining mucosa), says Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J.

Example: An otolaryngologist performs intramural radiofrequency ablation of the inferior turbinates (30802), submucous resection of the inferior turbinates using laser and the two-millimeter microdebrider and bilateral outfracture of the inferior turbinates. You should code this with 30140. CPT® convention considers the RF procedure (30802) and the fracture (30930, Fracture nasal inferior turbinate[s], therapeutic) inclusive in 30140, so you shouldn't report it separately.

Note: There is no specific code to use whenever RF procedures are performed on middle turbinates or superior turbinates. Use unlisted CPT® code 30999 (Unlisted procedure, nose) to report radiofrequency used on the middle or superior turbinates.