Wiki 30801 included in 30520??

[philnamba]

We are getting a denial from Aetna showing that cautherization of the inner nose (30801) is included in the repair of nasal septum(30520)...can anyone give me any guidence? When I look up the two codes in my coder's desk reference, it does not say that we do the cautherization with the repair.

 

[evonp]

EvonP

According to both CCI and Part B edits 30801 is not included in 30520.


CPT/HCPCS to CCI Code Check
Code / Description
30520 REPAIR OF NASAL SEPTUM M Non-Facility RVU: 14.67
No bundling issues exist
30801 ABLATE INF TURBINATE, SUPERF M Non-Facility RVU: 5.42
No bundling issues exist

Unless Aetna is making their own coding edits and not following CCI/Part B edits ,these codes should not be bundled. I would definately appeal this...maybe call Aetna (or check your contract with them if you can) and ask what coding edits they are using because the industry standard edits (CCI/Part B edits) do not bundle these codes. Good luck!