Wiki blue cross claim, need help please

[bench]

Hi Fellows,

I've been denied by Blue Cross for billing cpt code 30930-50 as the fracture of turbinates was done on both sides. They are saying that the code 30930 it self is already bilateral. CCI edits allows modifier 50 to this procedure but since the cpt book description says "FRACTURE NASAL INFERIOR TURBINATE(S)" this (S) they thought is already left and right side. As I was appealing this code, I told them that there are multiple turbinates in one side of the nose that makes the (S) there. But if you do it in left and right this should be paid as bilateral. But didn't matter, my claims is still denied and paid at one side only. Do you guys have any advise here or justification I could use so I won't be denied of this procedure as bilateral? I already attached copy of CCI edit page and also lay description but it didnot help.

Thanks very much.

 

[RebeccaWoodward*]

Per CPT Assistant.......

Subject Respiratory System, 30930 (Q&A)
Source CPT Assistant
Publication July 2001 / Volume 11, Issue 07
Effective Date Jul 1, 2001
Publish Date Jul 1, 2001


July 2001 page 11
Coding Consultation

Respiratory System, 30930 (Q&A)

Question

If therapeutic fracture of turbinates is performed bilaterally, should modifier -50, Bilateral Procedure, be appended to code 30930, Fracture nasal turbinate(s), therapeutic, or is code 30930 inherently bilateral?

AMA Comment

From a coding perspective, code 30930 is a unilateral code. Therefore, if therapeutic fracture of nasal turbinates is performed bilaterally, modifier -50 should be appended.

Bench,

Our local BCBS carrier requires units of 2 when billing with modifier 50. If this is not an issue, I would definitely appeal with the CPT Assistant statement.