Otolaryngology Coding Alert

Question: I filed a claim as follows:

California Subscriber

Answer: First of all, the Correct Coding Initiative CCI) bundled 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) and 30465 (Repair of nasal vestibular stenosis [e.g., spreader grafting, lateral nasal wall reconstruction]) until July 1st. As of July 1st, the bundle should no longer be in effect. If the surgery occurred before July 1st, you cannot be paid for both. Also, if your insurance company does not follow CCI edits, then you will have an uphill battle.

You won't find any bundle in CCI for 30140 (Submucous resection inferior turbinate, partial or complete, any method) and any of these codes. You should appeal, but be prepared for your insurance company to be an immovable force. They may tell you that 30140 represents the access site, but it does not. This procedure is for the inferior turbinates (which are not access to the sinuses), not the middle turbinates, and 30140 has been that way since 2006.

Red flag: Make sure you are not billing 30140 for radiofrequency shrinkage of the turbinates. For radiofrequency, you use 30802 (Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral, any method; intramural). Code 30140 has to be a submucousal resection, an actual cutting out from inside the mucosa.