Maria Posted Fri 20th of December, 2019 09:16:06 AM
What is the correct CPT code for the Latera Implant? The vendor continues to insist on 30465 which is an extensive surgical procedure. Is anyone getting paid for these services?
SuperCoder Answered Mon 23rd of December, 2019 01:43:54 AM
Please use unlisted CPT 30999 for latera implants as there is no appropriate CPT code for this procedure.
As per American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS), the only appropriate code for this procedure is 30999 (Unlisted procedure, nose). Consider the following justification from the AAO-HNS:
"The placement of an absorbable implant, such as Latera®, involves substantially less work, time, and effort than nasal valve repair using traditional rhinoplasty techniques, such as spreader or alar batten grafting. Under its current valuation, CPT® 30465 is assigned 120 minutes of intraservice (i.e. skin to skin) work, and it is nearly always performed in a facility setting. As placement of an absorbable nasal implant to treat valve collapse takes far less time than this and can be performed in the office setting, using CPT® 30465 to report this service would result in significant overpayment. Lastly, given the size of the discrepancy in time and work between traditional valve repair and placement of an absorbable nasal implant, appending modifier -52 (reduced services) also would not be sufficient to account for this difference. As such, CPT® 30999, (Unlisted procedure, nose), is the most appropriate code to use to report placement of an absorbable implant, such as Latera®, to treat nasal valve collapse."
Please find below SuperCoder newsletter for more understanding on the subject:
Maria Posted Thu 13th of February, 2020 08:49:35 AM
What is the HCPCS code for the actual implant? Is it separately billable?
SuperCoder Answered Fri 14th of February, 2020 07:40:12 AM
Appropriate HCPCS code would be C9749.
This procedure describes the insertion of the Latera™ absorbable nasal implant for supporting upper and lower lateral nasal cartilage.
Note: The C code for Latera can only be used by facility billing, for ASC or OR facility. It is a pass through so they can get paid for the implant in addition to their grouper. A physician cannot bill the C code and get paid for it.
Maria Posted Fri 14th of February, 2020 07:53:31 AM
This test is being performed in the office, not on at ASC or OPPS.
SuperCoder Answered Fri 14th of February, 2020 07:57:20 AM
There are some random payers that accept the C codes, but we don’t have a list of the payers that do. If you bill the C codes, you may or may not get additional payment for the device. That varies by payer.