Otolaryngology Coding Alert

Answer: You should report NSB reduction with 30117 (Excision or destruction (eg, laser), intranasal lesion; internal approach), but if the NSB reduction is performed during the same session as septoplasty, it should not be coded separately according to a CPT^® Assistant FAQ released in July 2019. The procedure described in code 30117 is considered inclusive to the septoplasty, so you would only report code 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft).

Keep in mind: When your ENT performs NSB reduction (no septoplasty) — on one or both sides of the nasal septum — you should only bill code 30117 one time for this service; never report 30117 as a bilateral code.

According to CPT^® Assistant, “Code 30117 … is reported once per surgical session, regardless of the number of nasal swell bodies that are excised or destroyed because the nasal swell bodies are part of the mucosa of the nasal septum, which is a midline structure. Therefore, the use of modifier 50, Bilateral Procedure, with code 30117 is not appropriate. Even though work is performed through both nostrils, all work is still being performed on a midline structure.” (November 2019; Volume 29: Issue 11)

Note: CPT^® 30117 is used for other nasal destructions, such as the posterior nasal nerve (PNN), and because this code has a medically unlikely edit (MUE) of 2, it may be used twice in one day when your ENT destroys lesions/tissue other than NSB on both sides the nasal cavity.

Because you cannot append modifier 50 to 30117 due to how the code is established in the Medicare fee database, you would instead report bilateral destruction, such as PNN ablation, in one of two ways:

• For payers, such as Medicare Part B, UnitedHealthcare, and some BCBS payers who recognize the X{EPSU} modifiers for separate procedures, code the service as:

30117-RT

30117-XS-LT

• For payers who do not recognize the X{EPSU} modifiers, report the destruction on both sides with:

30117-RT

30117-59-LT

Reasoning: Use modifier XS (Separate structure, a service that is distinct because it was performed on a separate organ/ structure) when it is recognized because payers are monitoring the use of modifier 59 (Distinct procedural service) and red-flagging high usage for audit. Reporting the X{EPSU} modifiers shows payers that the practice knows why and has the documentation to clinically support the unbundling that is present on the claim, whereas using modifier 59 may cause a payer to consider that the practice is trying to unbundle without justification and the appropriate documentation.

Note: Every payer has its own idiosyncrasies —some may frown upon use of modifiers LT (Left side) and RT (Right side), some may want two units reported — so be prepared to tweak these instructions based on the payer’s specific requirements for a two-sided procedure that cannot be coded as a bilateral procedure.