Wiki 30520 & 20912

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Hi Team,

I have a question about performing septoplasty and nasal graft on the same surgical session. One of our docs doesn't agree that these two codes can't be billed together.
 
The septoplasty includes range guidelines that say:
Range Specific Guideline
(For obtaining tissues for graft, see 15769, 20900, 20902, 20910, 20912, 20920, 20922, 20924, 21210)

Therefore, if the cartilage is obtained for the graft for the septoplasty, 20912 would also be coded per the instructions in CPT. Show the guidelines from the CPT manual to your surgeon. Also, these two codes are also not bundled per CCI. They are supposed to be billed together, Barbara
 
The septoplasty includes range guidelines that say:
Range Specific Guideline
(For obtaining tissues for graft, see 15769, 20900, 20902, 20910, 20912, 20920, 20922, 20924, 21210)

Therefore, if the cartilage is obtained for the graft for the septoplasty, 20912 would also be coded per the instructions in CPT. Show the guidelines from the CPT manual to your surgeon. Also, these two codes are also not bundled per CCI. They are supposed to be billed together, Barbara
According to codify "In nose related procedures, such as rhinoplasty, septoplasty, etc., if a nasal graft is procured during the procedure, note that 20912 refers to the source of the graft. When the nasal septum is the anatomic site requiring the repair, 20912 should not be used because the septum cannot be both the donor and recipient sites."
My understanding was if the graft is obtained through the same incision as another billable procedure it could not be reported. I have a physician that does excessive work with his septal graft during a septoplasty and it can take him an additional hour. I would love to be able to bill for the additional work if codify is incorrect.
 
Alyssa, I see that notation in the Tips section of 20912 in Codify. But keep in mind, I am not sure who writes these tips, but it is not the AMA. But the AMA does indicate Range Specific Guidelines for 30400-30630:
Range Specific Guideline
(For obtaining tissues for graft, see 15769, 20900, 20902, 20910, 20912, 20920, 20922, 20924, 21210)


It does not exclude this guideline for 30520 or for a Rhinoplasty, so I consider it appropriate to code the harvesting of the septal cartilage codeable as 20912. A separate incision for the septal cartilage should be made to code for 20912. From what I have seen in op notes, the septal cartilage is not harvested from the same incisions as those made to straighten the septum in most cases.

I checked and there are no articles in CPT Assistant under 30520 or 20912 that address the coding of the harvesting of septal cartilage.
 
According to codify "In nose related procedures, such as rhinoplasty, septoplasty, etc., if a nasal graft is procured during the procedure, note that 20912 refers to the source of the graft. When the nasal septum is the anatomic site requiring the repair, 20912 should not be used because the septum cannot be both the donor and recipient sites."
My understanding was if the graft is obtained through the same incision as another billable procedure it could not be reported. I have a physician that does excessive work with his septal graft during a septoplasty and it can take him an additional hour. I would love to be able to bill for the additional work if codify is incorrect.
what if it is a donor graft not harvested by the physician? he just trims it and preps it...is that billable
 
Alyssa, I see that notation in the Tips section of 20912 in Codify. But keep in mind, I am not sure who writes these tips, but it is not the AMA. But the AMA does indicate Range Specific Guidelines for 30400-30630:
Range Specific Guideline
(For obtaining tissues for graft, see 15769, 20900, 20902, 20910, 20912, 20920, 20922, 20924, 21210)


It does not exclude this guideline for 30520 or for a Rhinoplasty, so I consider it appropriate to code the harvesting of the septal cartilage codeable as 20912. A separate incision for the septal cartilage should be made to code for 20912. From what I have seen in op notes, the septal cartilage is not harvested from the same incisions as those made to straighten the septum in most cases.

I checked and there are no articles in CPT Assistant under 30520 or 20912 that address the coding of the harvesting of septal cartilage.
I appreciate your input! I'm learning from someone that started coding 15 years ago on accident and has never been credentialed. I get told " That's just the way it is" a lot when I ask why she wants me to code things certain ways.
 
Alyssa, that is probably the "rule" that most coders get quoted, "that is the way we have always done it." But we know that will not hold up when a dispute with a payer or the government takes place. Always ask to get it in writing. 😎
 
Alyssa, that is probably the "rule" that most coders get quoted, "that is the way we have always done it." But we know that will not hold up when a dispute with a payer or the government takes place. Always ask to get it in writing. 😎
I know this discussion is not recent, but I have been having this exact conversation recently. This was posted under another website: https://karenzupko.com/harvest-of-graft-for-repair-of-nasal-vestibular-stenosis/

"Harvest of Graft for Repair of Nasal Vestibular Stenosis​

July 22, 2021
Question:
We did a septoplasty and repair of nasal vestibular stenosis with spreader grafts using septal cartilage. We billed these codes: 30465, 30520 and 20912. Medicare does not bundle any of these codes. So why did we not get paid on 20912? Should we have used modifier 59 or XS on 20912 to get paid?
Answer:
You were likely not paid on 20912 because harvesting of graft material obtained through the same surgical exposure/incision should not be separately reported. The septal cartilage graft was harvested when you did the septoplasty (30520) which is considered the same surgical exposure/incision. In other words, 20912 is included in 30520. Therefore, you should have only billed 30465 and 30520. Consider yourself lucky that you did not get paid on 20912 because that would have been considered an overpayment for unbundling of codes."


Is this incorrect information?
 
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