Otolaryngology Coding Alert

Documentation Critical When Billing For Late Repair of Nasal Fractures

- Published on Mon, May 01, 2000
There is no specific CPT code for late repair of nasal fracture. As a result, otolaryngologists have no option but to choose from two imperfect series of codesrhinoplasty (30400-30420), which includes elements that usually dont apply to a late repair of nasal fracture only, and treatment of nasal bone fracture, which doesnt reflect the extra work performed by the otolaryngologist in refracturing the bone.

Although coding specialists tend to agree that either series is likely to be reimbursed if the procedure is documented carefully and completely, theyre split on which series of codes actually should be used.

Otolaryngologists may perform late fracture repair for a variety of reasons, which essentially fall into two categories: (i) severe swelling does not permit acute fracture repair (usually closed) to be performed; or (ii) the dorsum (nasal bone) may have healed incorrectly, either on its own or after a closed repair.

Coding Can Be Confusing

For example, a 15-year-old boy breaks his nose while away at school. The nose is reduced (21315, closed treatment of nasal bone fracture; without stabilization), but a few months later when he returns home and visits the familys otolaryngologist, the nose still is out of place. So the otolaryngologist performs an open repair of the nasal fracture by opening the boys nose, refracturing the dorsum and then reducing it.

Choosing a code in this situation can be a vexing problem. At first glance, repair of nasal fracture might seem the obvious choiceafter all, the physician is fixing a broken nosebut American Academy of Facial Plastic and Reconstructive Surgery (AAFPRC) coding guidelines clearly state that nasal fracture codes should be used to describe the handling of acute fractures only. Treatment of healed fractures and the sequelae of trauma, such as malunion and nasal airway obstruction, are coded using the rhinoplasty series.

Once the fracture heals, says Laurel Ferris, MA, CPC, an independent facial plastic coding specialist in Edina, Minn., It is no longer acute, and youre no longer dealing with a fracture but with the late effects of a fracture. If youre beyond the healing stage, you should use a rhinoplasty code.

The use of the term acute, however, comes with its own problems. The AAFPRC guidelines dont spell out exactly how many days a fracture can be termed acute, and although the fracture may not heal for two to three weeks, some coders make the window much shorter, as little as five to six days. After that, if the otolaryngologist performs a nasal fracture repair, they bill it as a rhinoplasty.

Ferris notes that both the AAFPRC and the American Society of Plastic Surgeons indicate that if the fracture no longer moves, it doesnt qualify as acute. By [...]

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