Thursday, March 31, 2011

Check out three FAQs to assist your turbinate surgery coding skills

If you have come face to face with a transnasal turbinate surgery claim, see to it that you put your clinical judgment on high alert considering the diversity of anatomic sites, surgical techniques, and types of instrumentation involved in this type of service.

Here are three FAQs to help master your turbinate surgery coding skills:

Should 30130 and 30140 go in tandem?

Imagine the documentation states that the doctor entered or excised mucosa and subsequently preserved it. This indicates to you that you should use 30140 to report this service. But then simply reporting that the turbinate was excised is most likely not enough documentation for this code. Do not forget to bill 30130 (Excision inferior turbinate, partial or complete, any method) if there is no evidence of the preservation of the mucosa and the op note just indicates that the inferior turbinate was excised or resected.

You shouldn't bill 30140 with 30130 - you'd bill one or other for a single side. But then if a submucousal resection (preservation of the mucosa) is performed on one side and a straight excision is performed on the other side (no preservation of mucosa), you would code 30140-RT and 30130-59-LT, for instance. The RT and LT would represent which side each procedure was carried out.

Facts: Normally, you'd code 30130 or 30140 separately with septoplasty or a functional endoscopic sinus surgery is carried out along with an inferior turbinate removal, either excision (30130) or submucous resection (30140), preserving the mucosa.

CPT 31240 describes the removal of a middle turbinate endoscopically. You'd code this when the concha bullosa is removed during endoscopic sinus surgery. CPTs 30130 and 30140 shouldn't be used if the turbinates excised non-endoscopically were middle turbinates. If the doctor removed the middle turbinates through excision or resection, as in a middle turbinectomy and septoplasty, you'd use the unlisted nasal code for the middle turbinectomy, 30999.

Important: You should always take 30130 and 30140, along with 30930 and 31240 as unilateral codes. This means that you add the modifier 50 if the doctor carried out the procedure bilaterally. CPT 30140 is “modifier 50-allowed.

How much can we get from uni turbinate claims?

You should note the different RVUs that unilateral turbinate codes carry so you can have an idea how much you'd be paid.

Remember that when the turbinate procedure is part of a multiple procedure surgery, it'll be divided in half when adjusted for the multiple-surgery reimbursement.

Does inferior and middle turbinates point to the same thing?

While billing 30130 or 30140 (inferior turbinates), the payer should not confuse your billing for it with the middle turbinates. Since year 2006, 30130's definition has been changed from “any turbinate" to “inferior turbinate." This was done since so many payers denied 30130 and 30140 when coded for inferior turbinates and endoscopic sinus surgeries thinking that the resection was performed on the middle turbinates which are considered access to the sinuses. By changing the wording and definition of the codes, there can be no question by the payer as to whether the procedure was carried out on the inferior turbinates.

If you're still puzzled, consult a good one-stop medical coding guide like Supercoder.