Otolaryngology Coding Alert

Step-by-step guide points you to 30400-30450 key words When you see "bony pyramid" and "mucoperichondrial flap," think "complete" and "septum" or you could land on a lesser-paying rhinoplasty code. Spotting key terms in a rhinoplasty operative note could boost you from 30400's $1,003 range to 30420's $1,332 realm, using the 2008 unadjusted Medicare Physician Fee Schedule assignments and conversion factor of 38.0870. Test Your Skills With a Case Study Your medical terminology passes muster if you can pin down the correct CPT code in this abbreviated "Nasal and septal reconstruction with external approach" op note: "Patient had nasal obstruction and septal deviation due to previous trauma. "I made a columella incision and then rim incisions, elevating the skin and soft tissue envelope from over the lower lateral cartilages as well as the upper lateral cartilages and bony dorsum of the nose. Cut septum's caudal end to open the mucoperichondrial flap. Elevated the contralateral flap. Resected a portion of cartilage. From along maxillary crest, resected bony spur with an osteotome and forceps. "After I corrected deformity all the way back to the vomer's perpendicular plate, I replaced the flaps and shaved a portion of the nose's bony dorsum with osteotomy. I made medial osteotomies and then lateral osteotomies and then reshaped the bony pyramid to alleviate the bony deformity ... I closed the flap with - " Step 1: Ask, -First or Revision?- First check whether the patient had previous nasal surgery or if this is the patient's first surgery in the area. The answer puts you in one of two code families. For a first surgery, use the primary rhinoplasty codes: - 30400 -- Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip - 30410 -- - complete, external parts including bony pyramid, lateral and alar cartilages, and/or elevation of nasal tip - 30420 -- - including major septal repair. If the patient has had a previous nasal surgery and this is a revision surgery (for instance, the patient's second or third surgery), report a secondary rhinoplasty. CPT classifies this procedure with three codes: - 30430 -- Rhinoplasty, secondary; minor revision (small amount of nasal tip work) - 30435 -- - intermediate revision (bony work with osteotomies) - 30450 -- ... major revision (nasal tip work and osteotomies). Solution: The above op note doesn't indicate a previous surgery or revision work. Therefore, you-re in the primary rhinoplasty code set (30400-30420). Step 2: Search for -Pyramid- Each ascending primary rhinoplasty code describes more work than the previous code. For instance, "30410 is more extensive than 30400," says Ben Willis, biller with Accurate Medical Billing in Tennessee. Speed tip: To distinguish a 30400 op note from a 30410 description, scan [...]