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.
- 31255-RT, 31259-LT
- 31253-RT, 31256-RT
- 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 30130, 30140 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 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.