Somnoplasty, a technique that uses low-energy, low-temperature radio-frequency to remove tissue obstructing airflow in the upper airway originally developed to stop snoring, is now approved for use with four distinct procedures uvulopalatoplasty, glossectomy, tonsillectomy and turbinate reduction to treat obstructive sleep apnea (OSA) or, in the case of turbinate reduction, nasal obstruction.
Note: Medicare and some other carriers consider snoring without an associated sleep disorder a cosmetic problem, meaning that somnoplasty of the soft palate, or any other treatment for a severe snoring problem, is not a covered service. Therefore, somnoplasty performed to treat a snoring problem should be billed the same as cosmetic surgery, for which otolaryngologists are paid directly by the patient.
Coding the Procedures
CPT generally does not distinguish procedures based on instrumentation (or illumination or magnification), and therefore does not include specific codes to describe uvulopalatoplasty, glossectomy, tonsillectomy and turbinate reduction performed with somnoplasty.
Consequently, if somnoplasty is used to remove a patients tonsils, the appropriate codes are 42826 (tonsillectomy, primary or secondary; age 12 or over) or 42825 ( under age 12). No modifier need be attached to the tonsillectomy code because 42825-42826 are the only available tonsillectomy codes.
Note: Somnoplasty is not used to remove infected tonsils. Rather, the procedure is used if the tonsils are hypertrophied and contributing to an airway obstruction.
When somnoplasty is performed on the base of the tongue, 41120 (glossectomy; less than one-half tongue) should be used. Modifier -52 (reduced services), however, should be appended to the glossectomy code.
At present there is no applicable code for reduction of the tongue, whether by laser, radiofrequency or cautery, says Lee Eisenberg, MD, an otolaryngologist in private practice in Englewood, N.J. and a member of CPTs editorial panel and executive committee. He notes that 41120 is understood to mean more than a simple reduction of tissue.
Similarly, reduction of nasal turbinates using somnoplasty should be coded 30140-52 (submucous resection of turbinate-reduced services) to indicate to the carrier that the procedure was not a complete submucous resection, but rather a reduction of turbinates. Although CPT does not include a code that specifically describes turbinate reduction, it does specify, for reduction of turbinates, use 30140 with modifier -52.
The closest code to removal of tissue from the soft palate (42145, palatopharyngoplasty [e.g., uvulopalato-pharyngoplasty, uvulopharyngoplasty) describes a more extensive procedure involving removal of tissue from the patients pharynx. Although 42145 with modifier -52 appended correctly describes a uvulopalatoplasty using somnoplasty, obtaining reimbursement for the procedure may prove difficult.
Reimbursement Problems and Solutions
