Wiki Aetna - CPT 30520 - Denied POS

[gvarnes7]

Has anyone had an Aetna denial for POS for 30520 done in office? If yes, please let me know what you have done to get this paid or if you have found something stating Aetna does not pay 30520 in POS 11.

Thanks In Advanced,
Gail

 

[b.cobuzzi]

Did your doctor perform the Septoplasty using a balloon to align the septum? That is what is usually performed in the office versus what is done in the OR. If only the balloon is used and no incisions are made in order to do the Septoplasty, like the sinus surgeries, you cannot bill the open code, 30520. 30520 means that incisions were made in order to do the Septoplasty. Sometimes a doctor may use the balloon and make incisions and then 30520 can be billed, since incisions are made and used to accomplish the Septoplasty.

But if the septum is straightened with only the balloon, you need to code 30999, unlisted nose procedure and use 30520 in box 19 of your claim for pricing. There was an article on this in either the January or February 2020 Otolaryngology Coding Alert.