Wiki Septoplasty and Swell Bodies

wsandner

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Needing some clarification- Am I able to bill septoplasty (30520) as well as septal swell body reduction (30999) during an in office balloon procedure?
I am also curious if I bill Turbs (30140) along with the septal swell bodies (30999) will they consider that to be unbundling? - as I have read the turbs(30140) are physiologically similar.
Lastly, can I use the cpt code 30117 x2 for swell body reduction instead of the unlisted code 30999 when the operative report says "bilateral destruction of intranasal tissue by shaver and cautery using internal approach - under nasal endoscopy a small incision was performed anterior to the swell body lesions, the shaver was introduced through this incision and the swell body lesions were shaved. The electric cautery was then introduced finalized the ablation of the swell body lesions, procedure was performed bilaterally."

Thank you so much for any and all information.
 
AMA CPT Assistant in July 2019 put out a FAQ about coding Nasal Swell Body Reductions (NSB reductions) and septoplasties. They said that the NSB reductions are coded 30117 but if the NSB reduction is performed at the same time as a septoplasty, the procedure is considered inclusive to the septoplasty and should not be coded separately.

Since 30117 cannot be billed as a bilateral code, when NSB reduction is performed on both sides of the septum (and no septoplasty is performed), the services should be billed one of two ways:

For payers who recognize the X[ESPU] modifiers for separate procedures, which includes Medicare Part B, United Healthcare and some BCBS payers, but not necessarily all of them, code the services as:
30117-RT
30117-XS-LT

For payers who do not recognize the X[ESPU] modifiers for separate procedures, code the NSB reduction on both sides as follows:
30117-RT
30117-59-LT

Every payer has it's own idiosyncrasies. Therefore, some payers may not like the LT and RT modifiers used, some payers may want 2 units used, etc, so these instructions may have to be modified based on the payers particular requirements for a two-sided procedure that cannot be coded as a bilateral procedure. Please keep that in mind. The reason I am recommending use of the XS modifier when it is recognized is that payers are monitoring the use of the 59 modifier and red-flagging high usage for audit. Usage of the X[ESPU] modifiers shows the payers that the practice knows why, and has the documentation for the unbundling that is present on the claim and the unbundling is clinically supported. Whereas, using a 59 modifier causes a payer to consider that the practice is trying to unbundle, without the documentation and justification.
 
What about 30117 for septum lesion removal (instead of Nasal Swell Body)? I am thinking that would be or considered included with septoplasty 30520 as well.
 
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