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Q:  Please explain again, when to report unlisted code for turbinate procedures?
A:  There are three turbinates: inferior, superior and middle.  There are parenthetical instructions in CPT following codes 30130, 30140, 30801, 30802 and 30930 that state these codes are only reported for procedures performed in the inferior turbinates.  If treatment is done on the middle or superior turbinates, CPT says to use unlisted code 30999.

Q:  For the last polling question of the webinar, should #3 be 31256-RT instead of 31267-RT? The polling question was as follows:
On the right side, a total ethmoidectomy, and a maxillary antrostomy, with removal of tissue.
On the left side, a total ethmoidectomy and a sphenoidotomy with removal of tissue from the sphenoid.

  1. 31255-RT, 31259-LT
  2. 31253-RT, 31256-RT
  3. 31255-RT, 31267-RT, 31259-LT

A:  The correct answer is #3.  On the right side there was a total ethmoidectomy, reported with 31255-RT.  There was also a maxillary antrostomy with removal of tissue, which is reported with 31267-RT.  CPT code 31256 is correct for maxillary antrostomy without removal of tissue, however, 31267 is used when tissue is removed.  For the left side, the combination code 31259-LT is reported.

Q:  At our facility, turbinate resection/excision is done endoscopically along with other sinus procedures. Are 30130, 30140, 30801, 30802 still appropriate codes for this procedure done endoscopically?
A:  Unfortunately, no.  There is only one endoscopic sinus code that involves procedures on the turbinates:  31240, concha bullosa resection. That code would only be used specifically to treat a concha bullosa, and not appropriate for a regular turbinate hypertrophy.  In order to report one of the other codes (30130, 30140, 30801, or 30802) the surgeon would need to directly visualize the turbinates (i.e., not  use a scope).  You will have to use an unlisted code for endoscopic resection/excision of the turbinates.

Q:  When coding a septoplasty for a deviated nasal septum, are there rules in coding that with a submucosal turbinectomy?
A:  Per the May 2003 CPT Assistant article:
“You may now be asking yourself, when can turbinate excision/submucous resection codes 30130 and 30140 be reported separately?  They are typically reported when referring to the inferior turbinate. It is important that the documentation reflects inferior turbinate when procedure codes 3013030140 are being performed. These codes can be reported separately with surgical procedures such as sphenoid, maxillary or frontal sinus procedures, and septoplasty.”
The inferior turbinate excision/resection codes do not bundle with septoplasty, 30520. Provider documentation should describe both procedures clearly, and identify the diagnosis or condition that is being addressed by each procedure to support medical necessity.

Q: My surgeon documents endoscopic balloon sinuplasty, is that the same thing as balloon dilation?
A:  Yes. Sinuplasty is a new technique in sinus surgery. Instead of using endoscopic instruments such as microdebriders and forceps, surgeons use balloons to dilate the sinus openings. This technique is similar to angioplasty, which is the use of balloons to open blocked blood vessels. Documentation should clearly identify the areas treated.

Q:  When codes 31231-31235 are reported for diagnostic nasal/sinus procedures, what portions of the nasal/sinus anatomy are examined?
A:  The endoscope is used to inspect the nasal/sinus anatomy including the interior of the nasal cavity, middle and superior meatus, turbinates, and sphenoidethmoid recess.

Q:  Can submucosal resection of the turbinates be reported with the endoscopic sinus procedures? For example, 30140 and 31255?
A:  Yes, the non-endoscopic procedures on the turbinates do not bundles with the endoscopic codes. Documentation should be clear with the 2 different techniques used.

Deanna Upston, CPMA, CPC, COSC

Deanna Upston, CPMA, CPC, COSC

Consultant

Deanna is a consultant for The Haugen Consulting Group with over 20 years of health care industry experience.  Her introduction was through medical assisting, which she enjoyed for several years. Once she was established at a surgeon’s office, she started coding their surgical cases and discovered that was her favorite part of the day. Deanna has experience working on the professional fee side of coding, audit, education and compliance serving coders and physicians.  She has put together multiple education sessions for both provider and coder.  She also has experience working as an analyst in which she validated the integrity of editing logic during the implementation of claim scrubbing software. 

14 Comments

  1. Claudia

    Hi, is it possible to bill 30520 together with 30140 on the same claim? What other different option would there be to bill these procedures? Thanks!

    • kkluglein

      Hi Claudia – Thank you for your inquiry!

      There is no NCCI bundling edit between these 2 codes and nothing in CPT that says do not report them together. They should both be able to be reported at the same session

      The AMA posted an article in the CPT Knowledgebase stating the following:
      “30520: If turbinate surgery (codes 30130 or 30140) is performed at the same session as a septoplasty (30520) or rhinoplasty (30462, 30420) can the turbinectomy be reported in addition?
      Answer: From a CPT perspective, it would be appropriate to report a turbinectomy in addition to a septoplasty or rhinoplasty when performed at the same session.”

  2. Marie

    When a patient has out fracture (and crush) and ablation of inferior turbinate can 30802 but code with 30930-59? The NCCI edit reads these two can not be coded but the CPT Assistant 2010 reads these two can be coded separately? So should we go with the 30802 because of the NCCI edit?

    • kkluglein

      Hi Marie –
      Our team suggests visiting The American Academy Of Otolaryngology’s site for additional information. https://www.entnet.org/resource/cpt-for-ent-reporting-radiofrequency-ablation-and-out-fracturing-of-inferior-turbinates/

      Per their page:
      Q. What are the appropriate codes to report when a physician performs a superficial (30801) radiofrequency ablation at the same session as out-fracturing both inferior turbinates?

      A. You cannot report this procedure with CPT code 30930-Fracture nasal inferior turbinate(s), therapeutic, because of an existing National Correct Coding Initiative (NCCI) edit (often referred to as a code bundle). However, if an intramural radiofrequency ablation is performed, 30802-Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral, any method; intramural may be reported, appending the -59 modifier-distinct procedural service. Report each CPT code only once since the descriptor states each is a bilateral service. This guidance applies to Medicare and most carriers that apply NCCI edits to their payment policy; carriers may, however, vary in their application of NCCI and other code edits.

  3. Amanda Collins

    When a patient has a sinus procedure with multiple global periods. 30140,21330 and 30520. Can we bill 31237 using modifier 79 during the post operative period? Or is 31237 considered part of the global period during the original surgical session?

    • kkluglein

      Hi Amanda! As long as the diagnosis documented for the debridement is different than the diagnosis documented as the reason for the surgical procedures that have the 90 day global, then modifier 79 with 31237 is supported. Check payor policy, and preauthorization requirements. 31237 is considered a surgical procedure so may need pre-auth.

      • Sharon Quinones

        Can you use cpt code 31267- 50 and 31259- 50
        Iam getting a denial for them. Patient had b/l etmoidectomy total and spheniotomy,tissue removal and bilateral maxillary antrostomy mucous membrane removal

        • kkluglein

          Hi Sharon – Yes, 31259 and 31267 should be able to be billed together. There is no NCCI bundling edit between them. Suggest asking for a rationale for the denial and/or appealing based on NCCI.

  4. Ginger Hill

    What CPT code do I use if the surgeon microdebrided both inferior turbinates but no incisions were made?
    “Attention was then turned to the turbinates. Lidocaine 1% with 1:100,000 epinephrine was injected along the length of the inferior turbinates bilaterally. Oxymetazoline soaked pledgets were inserted in each nostril. The inferior turbinate microdebrider blade was then used to remove bone and soft tissue from the right inferior turbinate. The turbinate was in-fractured, then out-fractured. The inferior turbinate microdebrider blade was then used to remove bone and soft tissue from the left inferior turbinate. The turbinate was in-fractured, then out-fractured. Suction cautery was used to achieve hemostasis along the inferior bleeding surface of each turbinate, with care taken to avoid the septum. Oxymetazoline soaked pledgets were placed in the bilateral nostril for additional hemostasis. Once hemostasis was achieved the pledgets were removed from the nose and ointment was applied to bilateral nasal cavities.

    Thank you,

    • kkluglein

      Hi Ginger, We passed this along to our training team. Their response was: The documentation still states turbinates were removed so 30130 still applies, it says by any method. Thank you!

  5. Jenifer

    I have a patient , the physician says he removed tissue from the posterior ethmoid only. How would I code this?

    • kkluglein

      Hi Jenifer,

      There is no CPT code for tissue removal from the posterior ethmoid only. Our team suggests using an unlisted CPT code, 31299, with CPT 31254 used as a benchmark for RVU’s.

      Thank you!

      • Nadine

        Hello, when tissue is removed during sinus surgery, what is considered as “tissue”?

        • kkluglein

          Hi Nadine –

          Sinus tissue would be any soft tissue present in the nose, other than bone, usually mucous membrane. Suctioning or removal of sinus secretions would not be considered tissue.

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