30465 x2 or 30465

karilynn

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Hi everyone! I would like some guidance with this 30465 code and a procedure I am seeing one of my plastic surgeons doing. He wants to use 30465 listed twice because he is placing an internal valve spreader graft AND a columellar strut graft (harvested from the nose). I am leaning towards 30465 being reported only once, thinking the one code should cover both grafts. Does anyone have any experience with this? (Please note that an ENT surgeon is performing a Septoplasty which we code seperately from the plastic surgeon, I am currently looking for guidance in the 30465 portion for the plastic surgeon.)

Copied from the OP NOTE:

PROCEDURE: Prior to the surgery, patient had markings made in upright position in holding area, V-columellar incision was planned next as well as preliminary position of the spreader grafts.

Patient was taken to the surgical suite and general anesthetic introduced. SCD device turned on before that. Nose injected by Dr. XYZ.

After that, a 15 blade is used to make V columellar incision that was carried in transfixion and marginal. Fine curved scissors were used to dissect skin flaps off the medial and lateral crura off the lower lateral cartilages. Interdomal ligament was severed, access to septum obtained. Case is then turned over to Dr. XYZ.

Out of the material Dr. XYZ took from the septum. I had fabricated the columellar strut graft 28 x 3 x 1.5 mm and 2 internal valve spreader grafts, there were 12 x 2 x 1 mm. When septoplasty was completed, then I dissected subperichondrial pocket and spreader grafts are placed in internal valve and subperichondrial secured in place with 5-0 PDS stitches. After that, columellar strut graft was placed sitting on the maxilla and then between medial crura and was secured with multiple 2-0 PDS stitches, once we reached the dome, I was able to attach the free end of the septal cartilage to the strut graft to and have a good tip support. Minimal cephalic trim and then reconstruction of the domal ligament with 5-0 PDS. After that, skin flaps redraped and then closed in the columella using 5-0 fast absorbing catgut intranasal and transfixion incision closed with 3-0 chromic catgut. Dr. Libi placed internal splints. I placed Steri-Strips. Extubated in room, transferred to recovery room in satisfactory condition.

Thanks for your help!

Kari
 

CodingKing

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I agree with the MUE. This is repair of nasal vestibular stenosis which means It doesn't matter how it was done. Also this is a bilateral code so if done unilaterally use modifier 52. The only thing that can be reported separately is obtaining the graft per AMA (30465 excludes obtaining graft. For graft procedure, see 20900-20926, 21210) So instead of looking billing 2 units see if any of these graft codes apply
 
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