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Otolaryngology Coding Alert

Is Your Practice Doing Concha Bullosa Work for Free?

Most ENT's are giving it away, but here's why you can bill 31240 separately

If you now bundle concha bullosa resection into ethmoidectomy or maxillary antrostomy, there's a new paper from a University of Pennsylvania researcher who says your otolaryngologist is losing $85 per procedure. Add 1 Turb Procedure to FESS-Also Bill The February 2007 Otolaryngology Coding Alert listed three times when middle turbinate work is not considered access and is thus billable. -There is one other exception for coding middle turbinate surgery, and that is if it is a concha bullosa endoscopic resection (31240, Nasal/sinus endoscopy, surgical; with concha bullosa resection),- says Sanford M. Archer, MD, FACS, associate professor of surgery, Division of Otolaryngology-Head and Neck Surgery at the University of Kentucky Medical Center in Lexington.

-I do not usually include the concha bullosa resection (31240) with the middle turbinate excision/submucous resection scenarios- that are coded to 30999 (Unlisted procedure, nose), says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J. Why: The 30999 procedures are open, and 31240 is an endoscope procedure.

Truth: You can separately bill endoscopic resection of concha bullosa of the middle turbinate (31240) that the otolaryngologist performs in addition to ethmoidectomy (31254-31255, Nasal/sinus endoscopy, surgical; with ethmoidectomy -) or antrostomy (31256-31267, Nasal/sinus endoscopy, surgical, with maxillary antrostomy ...). Separate 31240 Billing Trumps Bundled View Controversy has historically existed over whether you should bill the resection with ethmoid and/or maxillary sinus surgery. Some surgeons think that because the concha bullosa resection is a minor procedure, it should not be billed separately, Cobuzzi says.

But the scale is now tipping the other way, thanks to an article written by David W. Kennedy, MD, FACS, professor and director, Division of Rhinology, Department of Otorhinolaryngology: Head and Neck Surgery, vice dean for professional services and senior vice president, University of Pennsylvania Health System in Philadelphia. -Appropriate resection of a concha bullosa, with preservation of middle turbinate integrity, and preservation of the mucosa on both sides of the preserved lamella, and resection of areas of exposed bone does indeed create a significant time commitment,- he counters in -Should Excision of Concha Bullosa Be Reimbursed in Addition to That for Endoscopic Surgery?- published by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS).

Ethmoidectomy (31254-31255, Nasal/sinus endoscopy, surgical; with ethmoidectomy -) codes do not include the work value for concha bullosa resection (31240), says Kennedy, who was involved with the initial AMA relative value update committee valuation of the functional endoscopic sinus surgery (FESS) CPT codes. -The work value for ethmoidectomy does, however, include other forms of middle turbinate resection.-

Action: When an otolaryngologist operates on the ethmoids (31254-31255) [...]

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