Otolaryngology Coding Alert

Question: We have been billing 30117-RT and 30117-LT with modifier 59, but we’re only getting one line paid and not the other. Why is this happening, and what should we do when two-sided destructions are denied?

AAPC Forum Participant

Answer: Proper reporting will depend on the payer and procedure specifics; your payer may be relying on the AMA’s interpretation and guidance: When your ENT performs nasal septal swell body (NSB) reduction — on one or both sides of the nasal septum — you should only bill 30117 (Excision or destruction (eg, laser), intranasal lesion; internal approach) one time for this service; never report 30117 as a bilateral code.

The dilemma: Per 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)

Some experts disagree with the AMA. They argue that when ENTs enter the left and right nostrils to destroy one or more NSBs on each side, work is done on both sides of the nose, and it should be considered a bilateral procedure. In other words, the left and right nostrils are separate structures, so when NSBs are blocking airflow on both sides, destroying NSBs in each nostril is appropriate and billable.

Tip: Your case may be stronger if the doctors call them nasal swell bodies versus septal swell bodies, as this indicates they are destroying swell bodies in each nasal cavity.

When your claim is denied, appeal the denial. Explain that similar to performing nasal or sinus endoscopy on both sides of the nose/sinus, when your provider destroys NSBs on one side of the nose and then the other, the subsequent destruction represents a second procedure. Furthermore, 30117 has a medically unlikely edit (MUE) of 2, which means it may be used twice in one day. This should add to your case for getting the claim for two instances of 30117 paid.

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

• For payers, such as Medicare Part B, UnitedHealthcare, and some BCBS payers who recognize the X{EPSU} modifiers, append -RT (Right side), -XS (Separate structure …), and -LT (Left side): 30117-RT, 30117-XS-LT
• For payers who do not recognize the X{EPSU} modifiers, report the destruction on both sides with -59 (Distinct procedural service) instead: 30117-RT, 30117-59-LT

Note: CPT^® 30117 is used for other nasal destructions, such as PNN ablation. When 30117 represents removing a lesion/defect other than NSB from each side of the nose, you have a better case for getting both units paid.

Watch out: Every payer has its own idiosyncrasies, so be prepared to tweak these instructions based on the payer’s specific requirements for a two-sided procedure that cannot be coded with modifier 50.