Wiki LATERA implant for nasal valve collapse

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sigmathree137

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Our physicians are currently using the LATERA implant by spirox for repair of nasal valve collapse and I cannot find any information on how to code this. If this was a surgical procedure it would be coded as 30465, but this is an insertion of a biodegradable implant. The manufacturer does not have reimbursement guidelines on their website, but we just think that the insertion of the LATERA doesn't fit the description of 30465: The physician repairs a nasal vestibular stenosis using a variety of techniques. Separately reportable cartilage (e.g., auricular composite) graft may be used to support the cartilaginous skeleton and vestibular soft tissue scarring. In one external approach the physician makes an incision in the upper lateral cartilage, in another approach a "V" shaped cut may be made. In either case the incision is followed by an osteotomy of the medial aspect of the nasal bones. A spreader graft is placed to widen the nasal vestibule. The incision is closed or closed in a V-Y manner (lengthens the columella) with suture.

Anyone have any experience with this as the procedure is brand new??? Thanks!
 
As far as I can tell, there is no CPT / HCPCS code for this procedure, which is not uncommon for new procedures.

Based on your description, I would code this with unlisted code 30999 and send the claim with the operative note and a letter of explanation. Since I don't have an operative note, I am guessing that the amount of work/time involved is probably comparable to CPT code 30220 for insertion of a nasal septal prosthesis (button), which you would explain in the letter. I have a sample letter for unlisted procedures. Just PM me if you want it.

Hope this helps,

Jennifer M. Connell, CPC, CPCO, CPC-P, CPB, CPMA, CPPM, CPC-I, CENTC
 
Spirox latera implant

Hi,

Our facility is currently doing this case too. Implantation of spirox latera in the lateral nasal wall for nasal stenosis. The MD code this with 30465 as company Spirox provided them a reimbursement sheet that indicates CPT code 30465 and HCPC code for the latera L8699. How this procedure works is basically using a delivery device cannula that is inserted in the nasal mucosa of the lateral wall w/in the nasal cavity. The implant is being pushed from the delivery device into the nasal cavity. The implant is absorbed over time and is replaced by collagen, a structural protein produced by the body. This absorption and replacement process strengthen the nasal sidewall even after the implant has disappeared.

I kind of disagree as I think the code for this falls under unlisted 30999 based on the lay description of 30465. I think they are claiming this as 30465 since this procedure treats the nasal stenosis but the way it is done is different from the lay description. Another concern that I have is the latera, as they are claiming that this can be reimbursed as an implant with code L8699 rev code 0278. I was thinking that since this implant gets dissolve overtime this may not get reimbursed as this is not a permanent implant.

Any thoughts and information you can share, I really appreciate it.

Thanks.
 
I disagree with billing 30465 for this procedure. The CPT manual describes code 30465 (pg. 174 of 2017 CPT) as "an incision made in the upper lateral cartilage and continued as an osteotomy of the medial aspect of the nasal bones. The spreader graft is placed to widen the nasal vestibule." Additionally, the Procedure Desk Reference describes other techniques that may be used when billing CPT 3046, such as: "relocation and excision of reductant tissue (e.g. nasal caudal deviation, enlarge columella, and projected lateral alar crus), resection of scar tissue and replacement by a full thickness skin graft (e.g., cartilaginous malformation), replacement by local flaps, or by transplant of free cartilage, skin, or a graft (due to shortage of skin/cartilage)."

The procedure you described for implantation of spirox latera does not meet any of these criteria. I would bill this service with the unlisted code 30999. As for the implant, there is not a specific code and L8699 is the "unlisted implant" code specified in the HCPCS index. So that is the correct code and you would need to send supporting documentation, just as you would if you were billing a CPT unlisted code. It will be subject insurance coverage and reimbursement policies, which are hit and miss. Be prepared to appeal.

Hope that helps!
 
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