Grafts Are Separately Payable On Septal Perforation Repair
Published on Fri Sep 01, 2000
Repairing a perforated septum is a complex and time-consuming procedure. The CPT code used to bill for septum repair, 30630 (repair nasal septal perforations), has been assigned 16.96 relative value units (RVUs), or approximately $600, depending on where the procedure is performed. Some otolaryngologists believe this amount does not compensate adequately for what can be a three-to four-hour procedure.
If the perforation being repaired is large, however, any additional flaps or grafts may be coded in addition to the basic perforation repair, says Lee Eisenberg, MD, an otolaryngologist in Englewood, N.J., and a member of CPTs editorial panel and executive committee.
Finding the right codes for these operative sessions can be tricky because several different procedures may be billed, depending on the size and location of the perforation, as well as surgeon preference, says Eisenberg. He adds that coding and billing issues should be discussed ahead of time and received in writing from the carrier in question.
Cause and Treatment of Septal Perforations
Septal perforation can be caused by trauma, such as nasal picking or septal surgery (i.e., septoplasty or submucous resection of septum), as well as by septal abscess after a hematoma and granulomatous diseases. Abuse of cocaine or decongestant nasal sprays also may lead to septal perforation because both drugs are vasoconstrictors that diminish blood flow to the perichondrium, which covers the septum and provides its blood supply.
Such perforations can cause a variety of problems. For example, as mucous gets into the hole, its size diminishes, and may cause intermittent whistling. Some patients have crusting, which can lead to airway obstruction. Other symptoms can include discharge and epistaxis. In extreme cases, the perforation can cause the nose to collapse.
Although minor symptoms can be treated at home, using saline douches and ointment on the edges to diminish crusting, surgical repair of the perforation may be necessary. According to the Coders Desk Reference (CDR), this involves the creation of local mucoperichondrial flaps on either side of the perforation with a scalpel. Each flap is designed to expose one side of the septal cartilage while retaining mucosal coverage of the septal cartilage of the opposite side. The flaps are sutured in a single layer to cover the perforation.
If the perforation is larger than 1 cm, Eisenberg says, additional tissue may be required to enhance the repair. The flaps described in CDR are elevating local tissue, much like a regular closure. But with a large perforation, that may not be sufficient, he says. The additional tissue may be in the form of temporal fascia grafts or pedicle flaps, and such additional procedures are payable separately, according to the CDR.
How to Code the Procedures
Depending on the size and [...]
