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blue cross claim, need help please

  1. #1
    Default blue cross claim, need help please
    Medical Coding Books
    Hi Fellows,

    I've been denied by Blue Cross for billing cpt code 30930-50 as the fracture of turbinates was done on both sides. They are saying that the code 30930 it self is already bilateral. CCI edits allows modifier 50 to this procedure but since the cpt book description says "FRACTURE NASAL INFERIOR TURBINATE(S)" this (S) they thought is already left and right side. As I was appealing this code, I told them that there are multiple turbinates in one side of the nose that makes the (S) there. But if you do it in left and right this should be paid as bilateral. But didn't matter, my claims is still denied and paid at one side only. Do you guys have any advise here or justification I could use so I won't be denied of this procedure as bilateral? I already attached copy of CCI edit page and also lay description but it didnot help.

    Thanks very much.

  2. #2
    North Carolina
    Per CPT Assistant.......

    Subject Respiratory System, 30930 (Q&A)
    Source CPT Assistant
    Publication July 2001 / Volume 11, Issue 07
    Effective Date Jul 1, 2001
    Publish Date Jul 1, 2001

    July 2001 page 11
    Coding Consultation

    Respiratory System, 30930 (Q&A)


    If therapeutic fracture of turbinates is performed bilaterally, should modifier -50, Bilateral Procedure, be appended to code 30930, Fracture nasal turbinate(s), therapeutic, or is code 30930 inherently bilateral?

    AMA Comment

    From a coding perspective, code 30930 is a unilateral code. Therefore, if therapeutic fracture of nasal turbinates is performed bilaterally, modifier -50 should be appended.


    Our local BCBS carrier requires units of 2 when billing with modifier 50. If this is not an issue, I would definitely appeal with the CPT Assistant statement.
    Last edited by RebeccaWoodward*; 06-16-2009 at 06:35 AM.

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