Otolaryngology Coding Alert
Appeal Payer's Decision to Bundle 30560 With 30130
Question: One of our private payers has started bundling 30560 with 30130. I haven’t found these codes bundled in any of our resources. Is their bundling justified or should I appeal? If we should appeal, what do you suggest we use as our reasoning?
Many diagnoses can apply to 30560, but two common ones are 478.0 (Hypertrophy of nasal turbinates) or nasal obstruction (478.19, Other diseases of nasal cavity and sinuses). You didn’t mention a diagnosis for the procedure. Surgeons have many reasons for performing these procedures, so check the documentation to assign the correct diagnosis.
New Jersey Subscriber
Answer: Yes, you should appeal the payer’s decision to bundle 30560 (Lysis intranasal synechia) with 30130 (Excision inferior turbinate, partial or complete, any method).
Justification: Correct Coding Initiative (CCI) edits do not bundle the two services. Remind the payer that the surgeon performs the procedures on two separate anatomic sites and for different reasons. Be sure to include the different diagnoses justifying both procedures and any supporting documentation.
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