Otolaryngology Coding Alert

Do you know an excision from a reduction? Your reimbursement depends on it Considering that turbinate excision (30130) pays more than $350 per surgery, you can't afford to skimp on your documentation and face a claim denial. The following expert tips can help you shore up your turbinate coding and keep the denials at bay. Determine Whether Reduction Means Excision One of the most common turbinate coding errors is that coders often confuse the terms -reduction- and -excision.- Because these terms correspond to different codes, you should know these procedures like the back of your hand.

Consider the following operative note: -Xylocaine 1 percent with 100,000 of epinephrine was used to inject each inferior turbinate and middle turbinate. Using a Greenwald rongeur, each inferior turbinate was reduced by about 40 percent, and the edges were cauterized with a suction cautery. Both middle turbinates were also reduced in the same manner.-

The surgeon refers to a -reduction- of the inferior turbinates and the middle turbinates by 40 percent. Surgeons who use the term -reduction- often mean that they performed radiofrequency to reduce the turbinate.

But the physician also refers to a rongeur. Surgeons usually use rongeurs to actually excise the bone, says Cindy Terry, coding and reimbursement manager at ENT Billing Associates in Worcester, Mass. When otolaryngologists say that they excised a bone, they mean that they actually removed all or part of it. So which of the following codes is correct?

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

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

- 30802 -- Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral, any method; intramural

- 30999 -- Unlisted procedure, nose. Tip: Your best bet is to check with the surgeon and ask him whether he performed radiofrequency ablation of the turbinate. If so, you should report 30802.

If he excised the turbinates, you should report 30130 for the inferior turbinates and 30999 for the middle turbinates -- and give the otolaryngologist a few documentation tips for the future.

First, remind him that he should document an excision rather than a reduction. In addition, ask him what he meant when he referred to -40 percent.- If he cut out 40 percent of the bone, he should say that, because reduction by 40 percent may mean that he reduced the size using radiofrequency ablation and returned it to its prediseased state. Watch RFA as Closely as the Auditors What's the big deal? Beyond the fact that you-re coding incorrectly if you report 30130 for ablation procedures, you-re also setting yourself up for accusations of upcoding. The Medicare Physician Fee Schedule pays about $350 (not adjusted for geographic differences) for 30130 if you perform the [...]