Wiki Rhinoplasty denied for DX codes 30400

davacek

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Hello below I have a case that we billed the following CPT codes and DX codes. 30400 is being denied and when we called to get more information on this all the insurance company said is the DX codes are the issue. We are an ASC, 20912 was paid, but we are lost on 30400. Also below is more info from OP report.

30400
dx codes
M95.0
Z85.828

20912
same codes


POSTOPERATIVE DIAGNOSES: Saddle nose deformity following excision of a nasal dorsum malignancy with overlying scar over her nasal dorsum 1.5 cm in dimension with an equally large saddle nose deformity of the same dimension sinking in 4 mm.
PROCEDURE: 1. Closed rhinoplasty with dorsal nasal onlay cartilage graft. 2. Harvest septal cartilage, separate procedure.
 
Hi Davachek👃
I'd use differ CPT code too instead of CPT 30400.CPT 30400 is linked with cosmetic surgery & most payers do not like to pay this at all. I d use CPT 30150 Rhinectomy since in note is excision mentioned, then keep CPT code for the nasal cartilage graft . Also add dx T81.31 as primary dx. the problem developed after surgery
Well hope this helped you

:)
Lady T
 
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Thank you so much, we will give it a try
I would recommend caution in acting on some of the advice received here - coders who haven't reviewed all of the documentation can't make good recommendations about the correct way to code these situations.

In the case above, if the excision was performed at a previous encounter and not as part of the current procedure, then it wouldn't be appropriate to use the excision code to report as has been suggested above. You may be better off submitting an appeal to show that this was a medically necessary procedure to restore the patient's normal appearance after excision of a malignancy, and not a purely cosmetic service.
 
I would recommend caution in acting on some of the advice received here - coders who haven't reviewed all of the documentation can't make good recommendations about the correct way to code these situations.

In the case above, if the excision was performed at a previous encounter and not as part of the current procedure, then it wouldn't be appropriate to use the excision code to report as has been suggested above. You may be better off submitting an appeal to show that this was a medically necessary procedure to restore the patient's normal appearance after excision of a malignancy, and not a purely cosmetic service.
Thank you I am, when we called the insurance company they said it was denied do to the dx codes not the CPT code its self.
 
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