Wiki CPT 30117 denied for Investigational/Experimental

[bill2doc]

B.Shield has denied CPT 30117 as Experimental/Investigational. Has anyone successfully appealed and gotten paid? Is there a better code I should be looking at?

X returns to our office today for removal of internal nasal lesion. (Please refer to dictation from XX/XX/XXXX for complete historical details.) After reviewing the informed consent conference in detail (reviewing risks benefits, alternatives and prognosis, and pre- and post-care instructions), X indicated understanding of the above discussion and expressed to proceed with the procedure.

Under direct and endoscopic visualization, the left nasal cavity was first anesthetized with 0.5 mL of 2% lidocaine with 0.5% Neo-Synephrine solution. The 25-gauge needle was then utilized to inject 1.5 mL of 2% lidocaine with 1:100,000 epinephrine directly into the anterior portion of the left inferior turbinate. Under microscopic visualization, a linear incision was made in the anterior portion of the inferior turbinate, and dissection proceeded through the submucosal turbinate tissues, removing the lesion in its entirety, which was placed in formalin and sent off for histopathology. Hemostasis was achieved with the handheld cautery, along with topical silver nitrate. A light application os Surgicel packing was then applied. X tolerated the procedure well. Estimated blood loss less than 3 mm. Specimens include anterior turbinate lesion sent off for histopathology. Post-care instructions have been reviewed in detail with X, with follow-up planned in 10-14 days. X indicated understanding of the post-procedure management plan.

 

[nickelclaw]

I don't think it was coded correctly. 30117 excision techniques could be excision, cryosurgery, chemical application, or laser surgery
This was done endoscopically under direct visualization
31237

The physician performs endoscopic biopsy, debridement, or polypectomy of the nose. An endoscope has a rigid fiberoptic telescope that allows the physician both increased visualization and magnification of internal anatomy. Topical vasoconstrictive agents are applied to the nasal mucosa and nerve blocks with local anesthesia are performed. The endoscope is placed into the nose and a thorough diagnostic inspection of the internal nasal structures is accomplished. Any identified polyps or lesions are biopsied or removed by intranasal instruments placed parallel to the endoscope. Scalpels, forceps, snares, or other cutting and grasping instruments may be used to remove diseased or necrotic tissue from the internal nose, often in the form of postoperative debridement in cases of delayed healing or retained foreign material that interferes with the healing process. The nose may be packed if excessive bleeding occurs.

I know it states lesion but if path came back as turbinate bone. I would consider 30140
30140

The physician removes a part of or all of the inferior turbinate bone through a submucous incision. The physician places vasoconstrictive drugs on the turbinate to shrink the blood vessels. A full thickness incision is made over the anterior-inferior surface of the turbinate and continued deep to bone. The physician lifts the mucoperiosteum with an elevator to expose the bony turbinate. A chisel or forceps is used to remove portions of the bony turbinate. Electrocautery may control bleeding. The turbinate mucosa is closed in a single layer.

 

[bill2doc]

I don't think it was coded correctly. 30117 excision techniques could be excision, cryosurgery, chemical application, or laser surgery
This was done endoscopically under direct visualization
31237

The physician performs endoscopic biopsy, debridement, or polypectomy of the nose. An endoscope has a rigid fiberoptic telescope that allows the physician both increased visualization and magnification of internal anatomy. Topical vasoconstrictive agents are applied to the nasal mucosa and nerve blocks with local anesthesia are performed. The endoscope is placed into the nose and a thorough diagnostic inspection of the internal nasal structures is accomplished. Any identified polyps or lesions are biopsied or removed by intranasal instruments placed parallel to the endoscope. Scalpels, forceps, snares, or other cutting and grasping instruments may be used to remove diseased or necrotic tissue from the internal nose, often in the form of postoperative debridement in cases of delayed healing or retained foreign material that interferes with the healing process. The nose may be packed if excessive bleeding occurs.

I know it states lesion but if path came back as turbinate bone. I would consider 30140
30140

The physician removes a part of or all of the inferior turbinate bone through a submucous incision. The physician places vasoconstrictive drugs on the turbinate to shrink the blood vessels. A full thickness incision is made over the anterior-inferior surface of the turbinate and continued deep to bone. The physician lifts the mucoperiosteum with an elevator to expose the bony turbinate. A chisel or forceps is used to remove portions of the bony turbinate. Electrocautery may control bleeding. The turbinate mucosa is closed in a single layer.

Thank you very much. This was very helpful. I will take a look back at the notes with these codes in mind. Thank you again!