Wiki 30801 bundled to 31240

[ljones88]

I am trying to adequately understand the reasoning behind the bundling of 30801 and 31240. My scenario is this: Surgeon performed 31240 on the left and 30801 bilaterally. 30801 was completed in order to reduce hypertrophic inferior turbinates (not for cauterization of other procedures done on the same day). 31240 was completed on the left to remove the concha bullosa causing nasal obstruction.

We billed 31240/LT and 30801/59. 31240/LT was paid and 30801/59 denied as bundled. My argument is this: 30801 only mentions work done on the inferior turbinates (Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method). 31240 doesn't mention anything done on the inferior turbinates so I would argue that since the description of service in 31240 (Nasal/sinus endoscopy, surgical; with concha bullosa resection) and Work RVU does not include work on the inferior turbinates, both should be payable. Or at the very least, the right sided ablation should be payable. The concha bullosa occured on the left middle turbinate only which should further boost my appeal reasoning as a seperate and distinct service from the ablation done bilaterally.

Am I losing it or do I have a fighting chance? Does anyone know the true reason behind CPT bundling these two codes??

 

[JenniferB7]

As long as your documentation clearly supports what you have outlined below, then I would say you definitely have a fighting chance and I would definitely appeal. I almost always have to appeal claims involving 31240. It is a code that most insurance payers like to bundle (either into another service or other services into this code). I win nearly all of the appeals on this.

I would make sure that you outline clearly in your appeal letter that 31240 was performed on the middle turbinate and 30801 was performed on the inferior turbinate. You can go further to explain that 31240 is a unilateral code and does not include the RVU's for 30801 performed on the right side. Include copies of the pages from the CPT manual as well as a copy of the NCCI edit showing that CPT 30801 is payable with 31240 when documentation supports the use of modifier 59 (separate site).

Hope that helps!

Jennifer M. Connell, BA, CPC, CENTC, CPPM, CPCO