Wiki 30140 for turbs with FESS

[freespririt0806]

we are seeing a couple of denials (one from UHC mc aarp) stating -Based on Medicare coding and payment standards, as a partial / complete submucous resection INFERIOR turbinate by any method is a component of nasal / sinus endoscopy, surgical with ethmoidectomy partial or complete when performed to gain access to sinuses.
-Now i understand that middle and superior may be included, but i can not find anything on the inferiors included , and i have check Medicare
Does anyone have any such info?
TIA

 

[nsteinhauser]

As long as it's the inferior (like you highlighted) turbinates, like 30140, for instance, there's no NCCI edit between that and the FESS codes. Chapters 1 and 5 of the NCCI policy Manual (01/01/24 revision) don't have anything specific to 30140 except you can't code something separately that was done to 'gain access' to your true reason for the surgery. UHC may be assuming the only reason you would do a submucous resection of the inferior turbinates is to allow access to the sinuses. Or maybe UHC has found another way not to pay for something.
If the surgeon did it in order to advance the scope to the sinus portion of the case, then it's a component and won't be covered. If the surgeon had a totally separate indication/dx for doing it (like hypertrophy of the inferior turbinates causing other problems?) then it's not done to gain access (it's done to correct a separate problem) and therefore NOT a component of the FESS component(s) of the surgery.
Can you appeal with notes?

 

[freespririt0806]

As long as it's the inferior (like you highlighted) turbinates, like 30140, for instance, there's no NCCI edit between that and the FESS codes. Chapters 1 and 5 of the NCCI policy Manual (01/01/24 revision) don't have anything specific to 30140 except you can't code something separately that was done to 'gain access' to your true reason for the surgery. UHC may be assuming the only reason you would do a submucous resection of the inferior turbinates is to allow access to the sinuses. Or maybe UHC has found another way not to pay for something.
If the surgeon did it in order to advance the scope to the sinus portion of the case, then it's a component and won't be covered. If the surgeon had a totally separate indication/dx for doing it (like hypertrophy of the inferior turbinates causing other problems?) then it's not done to gain access (it's done to correct a separate problem) and therefore NOT a component of the FESS component(s) of the surgery.
Can you appeal with notes?

thank you for your reply, this is how i see it , and i think it is just another way for insurance to keep there money, and yes i will most definitely appeal