Otolaryngology Coding Alert

Unlisted-procedure code becomes the choice for middle turbinate fracture

For 2006, CPT will change the descriptors for 30130, 30140 and 30930 to specify -inferior turbinate(s)- rather than the nonspecific -turbinate(s)- (new text is bold):

- 30130--Excision inferior turbinate, partial or complete, any method

- 30140--Submucous resection inferior turbinate, partial or complete, any method

- 30930--Fracture nasal inferior turbinate(s), therapeutic. What it means to you: You should now limit 30130, 30140 and 30930 to procedures involving the inferior turbinate(s) only. You should not apply 30130, 30140 and 30930 for procedures involving the middle or superior turbinate(s), as you might have in years past.

The good news: -The change will allow clarity by telling payers that the ENT is definitely working on the inferior--not the middle--turbinate,- says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J. This can be a concern because some payers will bundle procedures of the middle turbinate to same-session endoscopic sinus surgery (31231-31294) or even septoplasty (30520).

-Payers may consider procedures of the middle turbinate as -access- for other procedures, and therefore may not pay separately. The problem arises because--in the past--even if the surgeon reported 30130, 30140 or 30930 for the inferior turbinate, the insurer might assume that the procedures referred to the middle turbinate and therefore would reject separate payment,- Cobuzzi says. By limiting 30130, 30140 and 30930 to the inferior turbinate(s), CPT 2006 should put an end to this problem.

The not-so-good news: ENTs who legitimately perform separate procedures of the middle or superior turbinate, such as excision, resection or fracture for reasons other than access, will no longer have dedicated CPT codes to describe their work as of Jan. 1, Cobuzzi says.

Parenthetical references in CPT now direct you to report 30999 (Unlisted procedure, nose) for excision, resection or fracture of the middle or superior turbinate(s). Using the unlisted-procedure code will require that you provide additional documentation and explanation, as outlined in -3 Tips Mean -Unlisted- Doesn't Have to Mean Unpaid- later in this issue.