You Be the Coder:
Septoplasty or Rhinoplasty
Published on Fri Dec 01, 2000
Question: My otolaryngologist and I disagree on how to code the following session:
A hemi-transfixation incision was made and a submucosal plane developed on the patients right. The quadrangular cartilage was freed from the maxillary crest and from the bony septum. Portions of the bony septum were resected and saved. An inferior cartilaginous spur to the right was resected. The quadrangular septum was scored vertically returned to the midline. The hemi-transfixation incision was closed and a running suture placed through the septum. An incision was made in the anterior aspect of the right inferior turbinate. The mucosal surface of the turbinate was elevated lateral and medial to the bone. The bone was resected and the incision closed. The same procedure was performed on the left. An incision was made cephalic to the right internal nasal valve and a pocket formed toward the piriform aperture. A piece of the previously resected bony septum was then trimmed and placed in the pocket as a stiffening graft. The incision site was closed with chromic. The same procedure was performed on the left.
The doctor says only a septoplasty (30520) was performed, but I think its a rhinoplasty with septal repair (30420). Can you help us code the session and resolve this difference of opinion?
Iowa Subscriber
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Answer: As described in the segment of operative note, the procedure in question was a septoplasty, says Lee Eisenberg, MD, an otolaryngologist in Englewood, N.J., and a member of CPTs editorial panel and executive committee.
Its not a rhinoplasty because no osteotomy was performed, and the op note doesnt indicate any nasal tip work, Eisenberg says. Therefore, this session should be coded as follows:
30520 septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft,
30140-50 submucous resection turbinate, partial or complete, any method-bilateral procedure.
The resection of turbinates is correctly billed with modifier -50 to indicate it was bilateral. Some carriers, however, may inappropriately bundle the turbinate resection with the septoplasty. If this occurs, you should appeal the denial because inferior turbinates are not considered incidental to septoplasty procedures and are separately payable, according to the American Academy of Otolaryngology-Head and Neck Surgeons, the American Medical Association and the National Correct Coding Initiative. Other carriers, meanwhile, may reject the bilateral turbinate claim.
Although cartilage from the septum was obtained, trimmed and then used as a stiffening graft, 20912 (cartilage graft; nasal septum) should not be billed because the graft is being obtained from the same anatomic site as the main procedure (i.e., the septoplasty), Eisenberg says, adding that 20912 is intended for [...]
