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Otolaryngology Coding Alert

You Be the Coder:

Appeal Faulty Bundles That Payers May Apply

Published on Thu Aug 27, 2009

Question: I filed a claim as follows: • 30465 • 30520-59 • 30140-50 • 30560 • 21235. The insurance company is bundling 30465 with 30520 and 30140 with 30560. Should we handle this as a second-level appeal or accept the payments received? California Subscriber Answer: First of all, the Correct Coding Initiative CCI) bundled 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) and 30465 (Repair of nasal vestibular stenosis [e.g., spreader grafting, lateral nasal wall reconstruction]) until July 1st. As of July 1st, the bundle should no longer be in effect. If the surgery occurred before July 1st, you cannot be paid for both. Also, if your insurance company does not follow CCI edits, then you will have an uphill battle. You won't find any bundle in CCI for 30140 (Submucous resection inferior turbinate, partial or complete, any method) and any of these codes. [...]
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