Otolaryngology Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: Our otolaryngologists placed stents in a newborn for nasal obstruction. The baby had nasal obstruction from enlarged turbinates, not choanal atresia. How should we code for this? Can we use 30540?

New York Subscriber   Answer: No. Code 30540 (repair choanal atresia; intranasal) should be used for choanal atresia only, says Lee Eisenberg, MD, an otolaryngologist in private practice in Englewood, N.J., and a member of CPT's editorial panel and executive committee. Choanal atresia is a congenital absence (or occlusion) of one or both choanae (the openings in the back of the nose) because the embryonic bucconasal membrane has failed to rupture. In a case of choanal atresia, bone is removed and stents are inserted to keep the bone from growing over the opening, allowing the child to develop a normal anatomy for breathing.

In this case, however, the turbinate bone is blocking the natural, existing opening. Therefore, the choanal atresia code is inappropriate. To code this procedure correctly, the coder must understand how the turbinates are being dealt with. If the otolaryngologist place tubes in the child's nose in the operating room, an unlisted procedure code (30999, unlisted procedure, nose) should be used. If the child was not taken to the operating room to place the stents, an appropriate-level E/M code should be reported.