Thursday, October 20, 2016

Procedure Code 30140, 30802, 30930


procedure Code           Description 

30802 -  Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg. electrocautery,  radiofrequency ablation, or tissue volume reduction), intramural (ie. submucosal) Average fee payment  $195


30140  Submucous resection inferior turbinate, partial or complete, any method - Average fee payment - $ 449



procedure code 30802 is used for both unilateral or bilateral procedures and may be reported only once per operative session. Use of the phrase “any method” in the code definition indicates that the specific instruments and techniques used to accomplish the reduction do not alter the code assignment. Intramural ablation of the turbinates includes any ablation of the  uperficial tissues so the code for superficial ablation (30801) is not assigned separately with 30802. procedure code 30140 is considered to be unilateral and would be billed with bilateral modifier-50.


INFERIOR TURBINOPLASTY WITH OUTFRACTURE

Turbinoplasty and outfracture are sometimes performed together. According to NCCI edits or procedure descriptions, procedure code 30930 should not be billed with 30140. If procedure codes code 30802 and 30930 are reported together, only one code is paid unless procedures are performed independently on opposite sides.


HOSPITAL OUTPATIENT CODING AND PAYMENT

Hospitals use procedure codes to report outpatient services. Payment shown is for Medicare’s APC hospital outpatient prospective payment system and is the Medicare national average without geographical adjustment. Status Indicator “T” = significant procedure, multiple reduction applies. Payment for each code is made at 100% of the rate when it is the only significant procedure billed. When billed with another status T procedure with higher weight, payment for lower weighted procedures is reduced to 50% of the rate.

CMS Final 2015 Outpatient Rule - CMS-1613-FC. Fee schedules are national averages and are not geographically adjusted.

 Status indicator “T” means “significant procedure, multiple procedure reduction applies”

NCCI edits apply to hospital coding as well as physician coding. If inferior turbinoplasty and outfracture are performed together on the same side, hospitals should report only 30930 for outfracture.


Multiple procedure discounting indicates that the procedures are subject to standard multiple procedure rules when performed together; one procedure is paid at 100% of the rate and the other is paid at 50% of the rate. Payment Indicator A2 means “Surgical procedure with transitional payment based on hospital outpatient relative payment weight”

Fracture Nasal Inferior Turbinate(s), Therapeutic with Submucous Resection


Coverage is subject to the terms, conditions, and limitations of an individual member’s programs or products and the edit criteria listed below. Please compare the claim's date of adjudication to the range of the edit in question. Prior versions, if any, can be found below.


30930 Incidental 30140

30930-59 Separate Reimbursement 30140


Rationale

Anthem Central Region bundles 30930 as incidental with 30140, bundles 30930-50 as incidental with 30140-50, bundles 30930-LT as incidental with 30140-LT and bundles 30930-RT with 30140-RT.

Based on procedure Assistant, Coding Consultation: Questions and Answers article:

Respiratory System/Surgery, 30930, 30140 (Q&A)

Question

Is it appropriate to report procedure code 30930, Fracture nasal turbinate(s), therapeutic, when performed in conjunction with 30140, Submucous resection turbinate, partial or complete any method, on the same turbinate?


AMA Comment

From a procedure coding perspective, it is not appropriate to report procedure code 30930 with 30140 if performed on the same turbinate. In addition, 30930 should not be reported with ethmoid sinus surgery if relating to the middle turbinate. When reporting code 30140, the documentation in the operative report should reflect that the physician entered/incised the mucosa and, for the most part, preserved it. The simple statement “excised the turbinate(s)” is often not enough documentation to reflect that the submucous resection of the inferior turbinate was performed. Coders may need to ask the physician for the specific technique performed.

Based on the National Correct Coding Initiative Edit, code 30930 is listed as a component code to code 30140. Therefore, if 30930 is submitted with 30140—only 30140 reimburses, if 30930-50 is submitted with 30140-50—only 30140-50 reimburses, if 30930-LT is submitted with 30140-LT—only 30140-LT reimburses, if 30930-RT is submitted with 30140-RT—only 30140-RT reimburses.

Anthem Central Region does not bundle 30930-59 with 30140 or does not bundle 30930-LT with 30140-RT. If the inferior turbinate is excised (30930) along with performing 30140, append modifier 59 to 30930 and both procedures reimburse separately (30930-59 and 30140). If 30930 is performed on one side of the nose, append the appropriate modifier LT or RT to reflect the side where 30930 was  performed and if 30140 was performed on the opposite side, append other LT or RT modifier to show 30140 was performed on the other side. Therefore, if 30930-59 is submitted with 30140—both services reimburse separately and if 30930-LT is submitted with 30140-RT—both services reimburse separately.

If on compliant/appeal it is documented that 30930 was performed on one side or was performed on the  inferior turbinate and 30140 was also performed--both procedures reimburse separately.

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