Otolaryngology Coding Alert

Question: My otolaryngologist performs a nasal vestibular stenosis repair (30465) as well as septoplasty (30520) that requires a cartilage graft (20912). May I report the septoplasty and/or the graft in addition to the nasal stenosis repair?

Arizona Subscriber

Answer: You should report both the nasal vestibular repair (30465, Repair of nasal vestibular stenosis [e.g., spreader grafting, lateral nasal wall reconstruction]) and the nasal septum graft (20912, Cartilage graft; nasal septum). CMS assigned work relative value units to 30465 with the understanding that the surgeon would not obtain the graft through the same incision as the stenosis. Because you may separately report the appropriate graft procedure (20900-20926, 21210), CMS assigns 11.64 work RVUs to the nasal vestibular repair code.
 
Two additional sources also reinforce that you may separately report the graft. Following 30465, CPT's parenthetical note states: "30465 excludes obtaining graft. For graft procedure, see 20900-20926, 21210." In addition, the National Correct Coding Initiative doesn't include 20912 in 30465.
 
Because the graft is a multiple procedure, you should append modifier -51 (Multiple procedures) to the lesser-valued procedure - the graft (20912-51).
 
But you should not bill 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) with 30465. NCCI bundles the septoplasty (30520) into the nasal vestibular repair (30465). The edit contains a "0" modifier, which means NCCI allows no unbundling of the 30520-30465 code pair.