Otolaryngology Coding Alert

Teach your staff this one vital rule: 1 turbinate = 1 code.

The feds and local authorities are cracking down on billing multiple inferior turbinate procedures. Take this quiz to make sure your ENT's turbinate coding would withstand the scrutiny.

Real consequences: An otolaryngologist almost lost his license for billing multiple turbinate procedures, warns 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.

Accurately Identify Inferior Turbinate Procedures

Question 1: On which turbinates does an ENT perform 30130-30140, 30801-30802 and 30930?

Answer 1: As of 2006 these codes all apply to the inferior turbinate(s) only:

• 30130 -- Excision inferior turbinate, partial or complete, any method
• 30140 -- Submucous resection inferior turbinate, partial or complete, any method
• 30801 - Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral, any method; superficial
• 30802 -- ... intramural
• 30930 -- Fracture nasal inferior turbinate(s), therapeutic.

If your ENT performs services on the middle turbinates, you should them using the unlisted code (30999, Unlisted procedure, nose) -- so long as your payer does not consider the service incidental to other procedures performed in the same operative session. For example, you would report a septoplasty and a left middle turbinectomy with 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) and 30999.

Include Fracture, Destruction in Excision

Question 2: Should you bill for multiple same-side turbinate procedures?

Answer: You can bill only one turbinate procedure per turbinate, Cobuzzi says. Because excision, cautery/ablation and fracture codes all apply to the inferior turbinate excision or resection, you should report only one of these procedure codes per side.

Example: An otolaryngologist performs a bilateral submucous resection of the inferior turbinates using laser and the 2-millimeter microdebrider and bilateral outfracture of the inferior turbinates.

Code it: You should report this session with 30140-50. CPT considers the fracture (30930) inclusive in 30140. "Do not report 30130 or 30140 in conjunction with 30801, 30802, 30930," states the AMA in the parenthetical instruction following 30140.

Use 59 for Other Side Turbinate Procedure

Question 3: Are separate sides an exception to the one-turbinate rule?

Answer 3: You should apply the "code one turbinate procedure per turbinate" (1 turbinate = 1 code) rule unilaterally. When reporting procedures performed on the inferior turbinate(s), you should assign a code for a second turbinate procedure on the opposite side.

Example: An otolaryngologist performs 30802 (cautery) on the right and 30930 (outfracture) on the left. The national Correct Coding Initiative (CCI) edits bundle 30802 and 30930, but a modifier is allowed to break the bundle under the appropriate circumstances. So should you report one inferior turbinate procedure or two?

Code it: The answer depends on whether the ENT performs 30802 and 30930 on the same side (the same inferior turbinate), or on two sides (different turbinates). You can use modifier 59 (Distinct procedural service) to override the edit if circumstances make the modifier appropriate, Cobuzzi says. "A modifier is allowed if and only if the procedures are done on different sites or different sessions." In these cases, you use modifier 59 to indicate a different site or different session.

Bottom line: "You cannot bill both procedures on the same turbinate," Cobuzzi says. Codes 30802 and 30930 are bundled when they are performed on the same site together.

Exception: So, in this example, if the otolaryngologist performs outfracture on the left and cautery on the right, you can use modifier 59 -- thanks to the different sites. Important: Always assign the code for the most complex procedure or the one with the highest relative value units. Inferior turbinate codes contain the following relative value units (RVUs) and bilateral surgery data elements based on the National Physician Fee Schedule:

30130                           11.08                                            1

30140                           12.77                                            1

30801                            6.60                                             2

30802                            8.47                                             2

30930                            3.61                                             1

* You can bill inferior turbinate outfracture (30930), excision (30130) and resection (30140) bilaterally, but cautery (30801-30802) only once, no matter how many sides the procedure is performed on.

Solution: When the otolaryngologist performs outfracture on the left and cautery on the right, you should code:

• 30801-RT
• 30930-59-LT.

The body-side alpha-modifiers (RT, Right side; and LT, Left side) are most often for informational purposes because most third-party payers do not process claims with body-side modifiers correctly. Appending modifier 59 to 30930 indicates that the outfracture was done on a separate site from the cautery (30801). Therefore, 30930 should not be bundled into 30801, and the carrier should pay separately for each procedure. Note: You can also use body side modifiers in addition to modifier 59.