Outpatient Facility Coding Alert
Report C9749 for Latera Implant in OPPS Setting
Question: I have a doctor that performed a “placement of bilateral Latera® implants for vestibular stenosis.” Should I bill this as 30465 or should I bill it using the new HCPCS code C9749? Mississippi Subscriber Answer: The American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS) advises that this procedure be coded as 30999 (Unlisted procedure, nose), not 30465 (Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal wall reconstruction)). This coding suggestion applies to physicians billing under the Medicare Physician Fee Schedule (MPFS). However, when billing under the Outpatient Prospective Payment System (OPPS) in a facility such as an Ambulatory Surgery Center (ASC) or hospital outpatient operating room (OR), the facility may report HCPCS code C9749 (Repair of nasal vestibular lateral wall stenosis with implant(s)) when the provider performs the placement of a Latera® implant for vestibular stenosis.
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