Otolaryngology Coding Alert

Correct Coding Initiative version 8.1 (CCI 8.1) (effective April 1-June 30, 2002) includes many new otolaryngology code edits, the most important of which are those bundling repair of nasal vestibular stenosis (RNVS) with rhinoplasty and septoplasty. Edits involving RNVS set new payment guidelines, mainly because 30465 (Repair of nasal vestibular stenosis [e.g., spreader grafting, lateral nasal wall reconstruction]) was introduced only recently (CPT 2001).

Although cerumen removal was already bundled with many audiological tests, CCI 8.1 bundles it with several more tests. CCI and many payers (including Part B carriers) bundle these procedures on grounds that the ears must be free of obstruction before tests can be performed. The edits represent Medicare's official ruling on the matter and end any speculation regarding whether cerumen removal may be billed with specific tests mentioned in the edits. Other edits in CCI 8.1, including those regarding planned tracheostomy (31600) and otolaryngologic examination under general anesthesia (92502), also bring the CCI in line with current coding practice. Repair of Nasal Vestibular Stenosis CCI 8.1 bundles RNVS code 30465 with rhinoplasty codes 30400, 30410, 30420, 30435 and 30450 and septoplasty code 30520.

Like most otolaryngology procedures, 30465 now includes as component codes 92502 and +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]).

Code 30465 is considered mutually exclusive with rhinoplasty codes 30460 and 30462, as well as 30620 (Septal or other intranasal dermatoplasty [does not include obtaining graft]). Bundling 30465 as a component of rhinoplasty and septoplasty codes creates a billing challenge, particularly with regard to septoplasty. When procedures bearing comprehensive and component codes are performed during the same session, only the comprehensive code is reported. There is little effect on reimbursement when one of the rhinoplasty codes is reported as the comprehensive code. These codes reimburse at rates close to, equal to or higher than the 22.19 relative value units (RVUs) set for 30465. It is an issue, however, when the septoplasty code is reported as the comprehensive code because the rate set for 30520 (12.04 RVUs) is less than that set for 30465. In this case, the effect on reimbursement is marked enough that you should contact your Part B carrier to express your concerns and question whether billing 30465 in place of 30520 is acceptable.

"This may be an error that the CCI will correct in a later version," says Elaine Elliott, CPC, an otolaryn-gology coding and reimbursement specialist in Jensen Beach, Fla. "I think they are bundling them because both rhinoplasty and septoplasty codes say with or without cartilage graft, and cartilage graft is also involved in RNVS. But RNVS is an entirely separate and much more delicate procedure than septoplasty because it involves [...]