Explore This IssueNovember 2013
When performing office-based surgery to correct inferior turbinate hypertrophy (ITH), success doesn’t just depend on clinical outcomes. Getting adequately reimbursed for these procedures to maintain a financially stable practice is also key, and the way to accomplish that is to brush up on your knowledge of Current Procedural Terminology (CPT) codes. So here are a few tips for ensuring proper coding of procedures and maximizing reimbursement.
1 Match the correct procedure with the correct CPT code. “In concept, at least, this is very simple: If you don’t assign the right CPT code to the right procedure, your payment claim is going to be denied,” said Dr. Setzen. “But the devil is in the details.” He noted, for example, that “if you remove the soft tissue of the turbinate via the submucosal approach, use CPT code 30140, no matter what method you use,” he said. “You can use a microdebrider, or you can simply resect tissue with any instrumentation, provided this is done submucosally.”
Becker’s ASC Review, an online source on business issues affecting physicians, notes that when the submucosal approach is not used, a different CPT code is required. For example, when radiofrequency (RF) coblation alone is used to reduce the inferior turbinates, code 30802—“cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral, any method; intramural,” in CPT terminology—should be assigned and submitted for reimbursement.
Dr. Setzen agreed that this is his coding approach. “If you’re only going to do soft tissue shrinkage via RF coblation, I use 30801 or in some cases 30802,” he said.
2 Don’t confuse inferior with middle turbinate surgery. “Turbinate surgery codes 30130, 30140 and 30930 are specific to the inferior turbinates and should not be coded for procedures performed on the middle turbinates,” Becker’s ASC Review notes. In cases where resection and some type of fracture of the middle turbinates are done, surgeons should code 30999.
3 Don’t let coding dictate surgical choice. Dr. Setzen noted that codes 30801 and 30802 are reimbursed at a lower level than 30140, reflecting the less extensive nature of procedures that involve only soft tissue shrinkage. “But, remember, the reimbursement level should never drive physician choice in what procedure to perform, and neither should the technology,” he stressed. “You should base the procedure on your expertise, the needs of the patient and the best level of evidence.”
4 Avoid turbinate tunnel vision. The same endoscopic and video-documenting equipment used in ITH surgery can be employed in a wide variety of functional endoscopic sinus surgery (FESS) procedures. Therefore, it’s important to focus on proper coding in all of those cases. Becker’s ASC Review contains numerous tips for accurate FESS coding. According to the website, one of the most basic FESS coding requirements is probably the most obvious, yet it is often overlooked—the need to use the codes only when an endoscope is actually used. As obvious as that sounds, the site notes that many audited practices have been penalized when it was determined that FESS codes were submitted even though the sinus surgery was done using Caldwell-Luc antrostomies or frontal sinusotomies and not by endoscopy. “There are separate codes for non-endoscopic access to all sinuses (see the 310XX and 312XX series),” the website states.