Otolaryngology Coding Alert

Question: What CPT code would you recommend using for nasal alar reconstruction using a cartilage homograft?

Victoria King, MD
Carson City, CO

Answer: The ala (plural: alar) is the soft part of the nose around the nasal passages. Sometimes the entire section of the nose needs to be excised due to cancer, so the physician tries to rebuild the nose.

In the scenario described above, there is no indication that any harvesting for the homograft was done. If the cartilage for the graft was not harvested from the body of the patient, but originated from a cadaver and was taken from a specimen bottle, the only procedure that should be billed is 30410 (rhinoplasty, complete, external parts including bony pyramid, lateral and alar cartilages, and/or elevation of nasal tip), says Ann Hughes, a practice coder in the office of Mid-Vermont ENT in Rutland, VT. If the cartilage was obtained by a local graft from adjacent nasal cartilage, no separate grafting code may be billed, because it is included in the 30410. If the graft was obtained from another part of the body, then the appropriate code in the 209xx series may be billed.