Increase Pay Up for Laser Ablation of Turbinates
Published on Wed Dec 01, 1999
Otolaryngologists should not code electrocautery or laser ablation of turbinates as a turbinate resection because it will cause loss of reimbursement by adding a 90-day global period. Not only is the turbinate resection code incorrect in this instance, but the 90-day global period means that any follow-up with the patient will not be reimbursed, says Barbara Cobuzzi, MBA, CPC, CHBME, president of Cash Flow Solutions, a physician reimbursement consulting firm in Lakewood, NJ.
Some otolaryngologists insist on documenting the procedure as a resection, so coders need to carefully read the entire operative report to determine what actually occurred so they can bill it accurately.
Resection/Excision vs. Destruction/Ablation/Cauterization
Although both procedures involve the removal of turbinate bone, they differ clinically and vary significantly in terms of reimbursement, Cobuzzi says. When turbinates are electrocauterized or ablated with a laser, they are destroyed, which means nothing will be sent to a pathology lab. When turbinates are excised, or resected, whatever was removed goes to pathology for analysis. Some otolaryngologists, however, still refer to the destruction of turbinates in their operative reports as a resection because the turbinate or a section of it is no more.
Many otolaryngologists perform either electrocautery or laser ablation of turbinates in their own offices. The procedure usually is performed when a diagnosis by CT scan shows nasal obstruction caused mainly by turbinate hypertrophy (478.0). The physician either may electrocauterize the turbinate or ablate it with a laser. The procedure, which should be coded 30802, is performed to remove excessive mucosa from the turbinates. The physician also may use a diagnostic scope to pinpoint the exact location of the section that is to be destroyed.
Although some otolaryngologists may be tempted to bill this procedure as a turbinate resection, Medicare requires physicians to code procedures to the highest level of specificity. In the case of electrocautery or laser ablation of turbinates, 30802 (cauterization and/or ablation, mucosa of turbinates, unilateral or bilateral, any method [separate procedure]; intramural) is a much more accurate description of the procedure that actually was performed than 30130 (excision turbinate, partial or complete, any method) or 30140 (submucous resection turbinate, partial or complete, any method). If there is a closer, more appropriate code you need to use it, so even if you argue that the ablation is a resection, its not the most specific code, Cobuzzi says.
Get Reimbursed for Subsequent Visits
Compliance with coding guidelines, however, is not the only reason that otolaryngologists and their staffs should use 30802 correctly when they cauterize or ablate turbinates. The procedure, which is considered relatively minor surgery, has a 10-day global period, while the global period for 30130 (excision turbinate) is 90 days.
Therefore, even though 30130 initially reimburses [...]
