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Proper billing for turbinate resection with use of coblation device

Kashonna Posted Mon 17th of June, 2019 16:43:06 PM
Our provider performed the following for one of our patients: “The Coblation device was inserted into the head of each inferior turbinate and advanced. Several applications of energy were applied along the length of each turbinate. The concha bullosa were compressed with the turbinate forceps and the redundance mucosa and bone removed using the biting forcep instruments to clear the middle meatus.” What codes should be billed based on services rendered?
SuperCoder Answered Tue 18th of June, 2019 04:53:34 AM

Hi Kashonna,

Greeting from SuperCoder!

Please let us know if the procedure was performed through nasal endoscopy? It would be appreciated if you can provide us little more information on it, which would help us to identify the appropriate procedure code.

Happy working!

Kashonna Posted Thu 20th of June, 2019 12:41:09 PM
Hello, in addition to the procedure mentioned above, our provider performed balloon dilation of the maxillary, frontal, and sphenoid sinuses. A nasal endoscope was used throughout this in office procedure. Our provider wants to bill CPT codes 31298-50, 31295-50, 30140-50, and 31240-50. Are these codes accurate?
SuperCoder Answered Fri 21st of June, 2019 07:21:24 AM

In CPT code 31298, the provider applies a topical nasal decongestant before beginning the dilation procedure. He gains access to the sinus through a nostril. A typical dilation method is balloon dilation. The provider places a flexible wire into the orifice in the frontal and sphenoid sinuses through the nose. He passes a balloon–tipped catheter over the flexible wire and introduces the tip into the orifice of the frontal and sphenoid sinuses. The provider confirms the position of the balloon using an endoscope and withdraws the wire. He then dilates the sinus ostia by inflating the balloon. The provider deflates and removes the balloon and endoscope at the end of the procedure. So, it can be billed for frontal and sphenoid sinus dilation.

Also, for maxillary dilation CPT 31295 can be billed. In this procedure, the provider applies a topical nasal decongestant before beginning the dilation procedure. He gains access to the sinus either through the nose or through an incision in the upper gums. A typical dilation method is balloon dilation. The provider places a flexible wire into the orifice in the maxilla or the opening to the maxillary sinus through the nose or through the upper jaw. He also ropes a balloon catheter over the flexible wire and introduces the wire into the orifice in the maxillary sinus, which is an opening near the roof of the sinus. The provider confirms the position of the balloon and the wire using an endoscope. He then dilates the sinus ostium by inflating the balloon.

Whereas, CPT 31240 is for endoscopic resection of middle inferior turbinate. In this procedure, the provider inserts an endoscope into the nasal cavity. After inspecting the anatomy, he also inserts a blade with the endoscope. With the help of the blade, the provider incises the front and sides of the concha bullosa, extending the incisions to remove the target area. Alternatively, she may use punch forceps to excise the concha bullosa. He takes care to protect the mucosa of the turbinate. The provider then removes the endoscope and applies cotton pledgets to the site to prevent any bleeding. The goal of the procedure is to remove the concha bullosa, typically one that is an extension of the ethmoid sinus in the middle turbinate. A large concha bullosa may disturb sinus drainage and nasal airflow.

For the inferior turbinate resection, CPT code 30140 can be billed as physician makes an incision into the anterior pole of the inferior turbinate and a submucosal dissection is performed. The inferior turbinates are elevated from the turbinate bone, allowing the surgeon to fracture the bone and reduce it while preserving the mucosa. The surgeon may also resect some of the lateral turbinate mucosa, to replace any remaining mucosa over the bare bone of the remaining turbinate. But, this is not an endoscopic procedure. However, Endoscopy Procedures on the Accessory Sinuses series is 31231-31298. Since, your all procedures are performed endoscopically and if your documentation is not matching with the procedure 30140, then use CPT 31299 (Unlisted procedure, accessory sinuses) for endoscopic inferior turbinate resection.

There is no CCI edits between all the provided codes, hence can be billed together, also modifier 50 is applicable with all the codes, modifier 50 can be appended. It is suggested to check the documentation completely and provide the medical necessity for all the procedures.

Hope this helps!

Kashonna Posted Fri 21st of June, 2019 16:44:08 PM
Our provider specifically used a coblation device to ablate the soft tissue of the inferior turbinates. The concha bullosa was then compressed with forceps, and both mucosa and bone were removed. For the portion of the procedure in which he ablated the inferior turbinates, would CPT code 30140 still be appropriate or should we be billing 30801 instead?
SuperCoder Answered Mon 24th of June, 2019 05:02:16 AM

The surgeon is reaching to the bone and removing it (deep penetration), so CPT 30801 would not be appropriate, because in this procedure the superficial area ablation has been performed. When comparing CPT 30140 and 30801, in the procedure 30140, physician makes an incision into the anterior pole of the inferior turbinate and a submucosal dissection is performed. The inferior turbinates are elevated from the turbinate bone, allowing the surgeon to fracture the bone and reduce it while preserving the mucosa. The surgeon may also resect some of the lateral turbinate mucosa, to replace any remaining mucosa over the bare bone of the remaining turbinate, whereas in the procedure 30801, the provider chooses from various possible ablation methods to shrink the superficial surface layer of the inferior turbinates. As an example, in bipolar cautery, the provider inserts a needle, approximately 2 mm deep, in the front of tip of the inferior turbinates. He then passes current through the needles to reduce the hypertrophy of the turbinates.

On the other hand, both the procedures, can be performed by any method, so coblation device also can be considered.

Hope this helps!

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