Otolaryngology Coding Alert

If you want to stop denials for 30130-30140 performed with 31254-31255, you're going to need to help your payers by providing not only spotless coding and documentation but perhaps some modifiers as well. To obtain reimbursement for inferior turbinate procedures, you should understand why payment isn't straightforward. Although the National Correct Coding Initiative (NCCI) does not bundle 30130 (Excision turbinate, partial or complete, any method) and 30140 (Submucous resection turbinate, partial or complete, any method) with 31254 (Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial [anterior]) and 31255 ( with ethmoidectomy, total [anterior and posterior]), many insurers deny claims for turbinec-tomies and ethmoidectomies performed together for several reasons, says James N. Palmer, MD, assistant professor in the division of rhinology in the department of otorhi-nolaryngology, head and neck surgery at the University of Pennsylvania in Philadelphia. For instance, some companies consider middle turbinectomies incidental to ethmoidectomies because the otolaryngologist performs them through the same incision. And insurance companies may deny payment on the basis that the physician excised the turbinate to gain access to the ethmoid. To further complicate the situation, 30130-30140 do not distinguish between the inferior and middle turbinates. And most insurers bundle middle turbinectomies with ethmoidectomy, thinking the claim is for a middle turbinate excision rather than an inferior turbinectomy, Palmer says. Consequently, operative notes that clearly delineate which turbinate bone the surgeon removed and why are crucial for payment. Encourage Separate Documentation To avoid erroneous denials from insurers, make sure the surgical notes fully explain the performed procedures. "The otolaryngologist should dictate a separate paragraph for the turbinectomy and ethmoidectomy," Palmer says. Having the operations individually described will help the payer see that they are indeed separate procedures and should be reimbursed as such, he says. Identify Turbinate Bone for 30130-30140 The physician should describe each procedure in the operative report's body using correct, specific language, says Teresa M. Thompson, BS, CPC, an ENT coding specialist and the owner of TM Consulting, a national medical consulting and management firm in Sequim, Wash. For instance, with turbinate procedures, the otolaryngologist must identify the exact turbinate bone that he or she removes, Thompson says. Failing to identify that the surgeon removed the inferior turbinate will lead the payer to assume that the doctor operated on the middle turbinate bone by default. In this case, the insurer may deny the turbinectomy (30130-30140) as incidental to the ethmoidectomy (31254-31255). For instance, an operative report that states, "Excised turbinate and anterior ethmoid; removed disease" omits vital information. The coder, as well as the payer, cannot discern which turbinate bone the physician operated on. The insurer will assume that the otolaryngologist excised the middle turbinate and will bundle 30130 with 31254. This error will [...]