Reader Question: Cyst Removal Sparks Denials- Published on Sun, Jun 01, 2003
Question: When we perform sinus surgery, specifically procedures 30520, 31255-31256, 31276 or 31287, the insurance companies state that 31240 is inclusive. The National Correct Coding Initiative edits show that this is not correct. How should I bill the concha bullosa service, and can you offer any assistance for arguing this matter with insurance companies? Nebraska Subscriber Answer: Concha bullosa is an intranasal cyst causing distention (stretching or swelling) of the middle turbinate bone. Most insurance companies deny the procedure (31240, Nasal/sinus endoscopy, surgical; with concha bullosa resection) on the grounds that the otolaryngologist usually has to shrink the cyst to gain access to the septum or one of the sinus cavities, such as the ethmoid (31255, Nasal/sinus endoscopy, surgical; with ethmoidectomy, total [anterior and posterior]).
Many otolaryngologists argue that these bundles are inappropriate because not every patient needs the concha bullosa excised to conduct ethmoidectomy. And, the doctors explain that the resection adds time and difficulty to the surgery. Despite these arguments, many coders struggle with frequent denials. Proper documentation and diagnoses that support the otolaryngologist performed the resection for airway obstruction (for instance, 519.8, Other diseases of respiratory system, not elsewhere classified) or hypertrophy of nasal turbinates (478.0) and not to access the ethmoid may help bolster your case. Attaching modifier -59 (Distinct procedural service) to 31240 may help the payer recognize the operation as a separate procedure. Although you may want to appeal denials involving 31240 and 31255 based on separate sites, some otolaryngologists do not feel that coders should separately report the simple procedure. Because the concha bullosa is a stretching of the middle turbinate bone, which is part of the ethmoid bone, 31240 and 31255 are technically part of the same anatomy, according to the American Academy of Otolaryn-gology Head and Neck Surgery. Thus, they do not qualify as separate sites, making denial appear more justifiable. You should fight all bundles involving concha bullosa resection when you bill it without ethmoidectomy and instead with septoplasty (30520, Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) or other sinus surgeries, such as 31256 (Nasal/sinus endoscopy, surgical, with maxillary antrostomy), 31276 (Nasal/sinus endoscopy, surgical with frontal sinus exploration, with or without removal of tissue from frontal sinus) or 31287 (Nasal/sinus endoscopy, surgical, with sphenoidotomy).