Wiki Turbinate Outfracture and Reduction HELP

[ms.coderll]

Please help: I code for an ASC and there is a surgeon who performs Septoplasty (30520) along with Reduction of the Inferior Turbinate using Coblation inferiorly and superiorly (30802) and then following that the inferior turbinates are therapeutically outfractured (30930).

I see that there is a CCI edit conflict between 30802 and 30930, so which one would you code if you can only code one, I'm confused because one code does not include the other?? I believe you can bill it using modifier 59 however some payors still don't cover it.

Thanks in advance for help on this one

 

[mdmoney]

IMO: I believe that the 30930 would be included in 30520. In my pratice they do this everytime when performing 30520 so I do not bill for it as it is part of the bigger picture. My advise would be to read the op-report to be sure it's not just part of a bigger picture.

HTH

 

[mburke81]

I generally bill both 30930 and 30802-59. If the chare is denied, I appeal and usually get paid, other than the medicaids.

 

[Candice_Fenildo]

The answer depends on whether the ENT performs 30802 and 30930 on the same side of the turbinate or on two different turbinates. You can use modifier 59 (Distinct procedural service) to override the edit if circumstances make the modifier appropriate.
A modifier is allowed if and only if the procedures are done on different sites or different sessions.
You can use modifier 59 only when you need to indicate a different site or different session.
Bottom line: You cannot bill both procedures on the same turbinate. Codes 30802 and 30930 are bundled when they are performed on the same site together.