Otolaryngology Coding Alert

Question: Which CPT codes should I submit for the following operation: Septoplasty. Nasal endoscopy with bilateral total ethmoidectomies, bilateral maxillary sinus antrostomies with antroscopy and tissue removal. Bilateral inferior turbinoplasties?

Georgia Subscriber

Answer: You should report four of the six procedures. The nasal endoscopy and the antroscopies are not separately billable.

Surgical endoscopy always includes a diagnostic endoscopy. So you may not separately report 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) in addition to 31255 (Nasal/sinus endoscopy, surgical; with ethmoidectomy, total).

Code 31256 (Nasal/sinus endoscopy, surgical, with maxillary antrostomy) is a component of the more complex 31267 (- with removal of tissue from maxillary sinus). So when documentation indicates the otolaryngologist performed a maxillary sinus antrostomy and removed tissue, such as "removed cysts in the maxillary antra," you report 31267 but not 31256.

When coding the bilateral inferior turbinoplasties, pay attention to preservation versus excision. You should use 30140 (Submucous resection inferior turbinate, partial or complete, any method) if the description of the submucous resection of the turbinates reflects "that the physician entered/incised the mucosa and, for the most part, preserved it," says Susan Garrison, PCS, FCS, CCS-P, CHC, CPC, CPC-H, CPAR, executive vice president of Magnus Confidential Inc. in Atlanta. If the otolaryngologist fully cuts through the turbinate bones, mucosa and all, you should use 30130 (Excision inferior turbinate, partial or complete, any method) instead of 30140. You would submit for Medicare the following CPT codes if the documentation supports each procedure:

- For the septoplasty, report 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft).

- Code the bilateral total ethmoidectomies with 31255-50 (Bilateral procedure).

- For the "bilateral maxillary sinus antrostomies with antroscopy and tissue removal," report 31267-50.

- Also, use modifier 50 on the inferior turbinoplasty code: 30140-50 or 30130-50.

Expect multiple-procedure payment reductions on the septoplasty, bilateral antrostomies with tissue removal and turbinoplasties. A Medicare carrier would reimburse:

- 30520 at 50 percent

- 31255-50 at 150 percent

- 31267 at 50 percent x 2

- 30140 at 50 percent x 2.