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.
Looking for additional information regarding this topic?
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.
My provider is billing 30520 and 30630. The patient had the 30520 a second time due to continued issues. Aetna is denying the 30520 stating is is included with the payment of the 30630. incidental to primary procedure. With no NCCI edits, I am unsure how to bill this. Can we use Modifier 22 on 30630 septal perforation repair, for the additional work for the deviated septum revision?
Hi Debi – You are correct, there is no NCCI bundling edit between the 2 codes, so this sounds like a policy specific to Aetna. We are unable to address individual payor polices so we suggest you reach out them directly. We cannot advice to add a modifier 22 to the service without seeing documentation, and it would not be appropriate to use modifier 22 to bypass a payors bundling edit. – Haugen Academy Learning Team
Hi I need your Coding expertise and help. I have an ENT surgeon that is reporting CPT 30130 at place of service 11. However, I do not agreed that this is the procedure he is performing as the op-notes states the following: Shaver:
The patient was placed in the supine position after the consent discussion and after the consent was signed by the patient.
The patient was prepped and draped in the usual sterile manner.
Inspection of the nose demonstrated severe bilateral inferior turbinate hyperthrophy with medial displacement.
After inspection, the nose was sprayed with neosynephrine bilaterally. 6% tetracaine gel was then placed in each nasal vault along the length of the inferior turbinates.
1% lidocaine with 1:100,000 epinephrine on cotton pledges were also placed in each nasal vault.
After adequate sedation was achieved, the pledgets were removed. 1% lidocaine with 1:100,000 epinephrine was then injected submucosal into each inferior turbinate. Attention was turned to the right inferior turbinate.
After further anesthesia was achieved, a goldman bar was used to displace the inferior turbinate laterally to help improve the airway.
Using a #11 blade an incision was made in the head of the right inferior turbinate. The shaver with a number 3 blade was introduced submucosal and the hypertrophied tissue was removed. Injection of 0.5 cc of Kenalog 10 was then performed intramucosal in the right inferior turbinate.
A cotton pledget was replaced into the right nasal vault for approximately 5 minutes and then removed with no bleeding seen from the incision site.
The same procedure was then carried out on the left inferior turbinate.
The patient tolerated the procedure well and was taken to a waiting area without any bleeding or respiratory distress. Is CPT 30130 the correct code, and if so, can it be performed at POS 11? as we are getting lots of denial for invalid POS.
Hello,
The procedure described appears to be a submucosal resection of the inferior turbinates. The correct CPT code would 30140.
We are unable to address the POS denials because payors all have different polices but suggest that pre-authorization is obtained from the patients insurance for the procedure to be performed in an office.
Haugen Academy Learning Team
If a middle and/or superior turbinectomy is performed with a maxillary antrostomy, frontal sinusotomy, or sphenoidotomy, is this bundled or is the unlisted code (30999) reported. I understand that they are bundled with an ethmoidectomy, but was uncertain as to whether they bundled with the other major sinus procedures.
Hi Jennifer,
Middle and/or superior turbinectomy is reported with the unlisted code 30999 and unlisted CPT codes are not subject to NCCI bundling edits. Payors may have their own policies so make sure documentation supports the service performed has medical necessity.
For 31231 (Diag nasal endoscopy), post FESS, when a patient has altered anatomy, and a provider is unable to visualize all of the specified/relevant areas for the code (listed in the CPT Manual instructions), should modifier 52 be assigned? Providers are indicating that performing the endoscopy, post FESS or other post surgeries, is sometimes more work than a normal endoscopy, thus, modifier 52 does not seem appropriate. Providers are indicating that the ‘intent’ is to perform a comprehensive exam, but are unable to do so in some circumstances. If all of the designated nasal areas are not documented, are there any situations/exceptions where modifier 52 does not need to be assigned?
Hi Paul,
CPT Guidelines state the following:
Codes 31231-31235 for diagnostic evaluation refer to employing a nasal/sinus endoscope to inspect the interior of the nasal cavity and the middle and superior meatus, the turbinates, and the spheno-ethmoid recess. Any time a diagnostic evaluation is performed all these areas would be inspected and a separate code is not reported for each area. To report these services when all of the elements are not fully examined (eg, judged not clinically pertinent), or because the clinical situation precludes such exam (eg, technically unable, altered anatomy), append modifier 52 if repeat examination is not planned, or modifier 53 if repeat examination is planned.
Unfortunately, there are no other resources or guidance that state differently than CPT.
I’m looking for a simple Sinus Cleaning and Suction CPT code, in office procedure ?
Hi Anthony, There is no CPT code for sinus suction and cleaning only. That work would be included in an E/M service.
Hello,
Our office bills for a septoplasty with turbinates repair, cpt codes 30520 and 30140-51. Our doctor recently informed us that he does a Extracorporeal Septoplasty.
I am new to coding and I do not see anywhere in the cpt book a different cpt code for this type of septoplasty.
I would appreciate any insight!
Thank you so much!
Hi Valerie,
There is not a separate code for an extracorporeal septoplasty – 30520 is all we’ve got. You could append modifier 22 (increased procedural services) if the operative note supports it.
Modifier 22 – When the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. Documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient’s condition, physical and mental effort required).
We hope this helps!
Hello! we are billing 30520, 31257, 31276, 31267, 30140 and 61782 and anthem bcbs always denies the 31267 for bundling. Is this correct or how do i get around this?
Hi Amy,
While there is no NCCI bundling policy between those codes, Anthem BCBS provider reimbursement policy may differ. I would suggest contacting your Anthem BCBS Provider Relations Representative for assistance in understanding their reimbursement policy specific to the codes you are reporting for this service.
Thank you,
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!
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.”
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?
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.
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?
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.
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
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.
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,
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!
I have a patient , the physician says he removed tissue from the posterior ethmoid only. How would I code this?
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!
Hello, when tissue is removed during sinus surgery, what is considered as “tissue”?
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.