There are many procedures that are done to the nose, including turbinate resection, repair of nasal vestibular stenosis, septoplasty, endoscopic sinus surgery to name a few. These can be tricky to code in CPT, and documentation of course is key.
Turbinate hypertrophy can cause an altered sense of smell, dry mouth, nasal congestion, facial pain and snoring. This can be an acute or chronic condition and is often accompanied by a deviated septum. There are three levels of turbinates in each nasal cavity: the superior, middle and inferior. Different levels or severity of hypertrophy include normal, moderate, severe and obstructive, which can be caused by medication, infections (colds, sinusitis, etc.), dust or allergies (rhinitis). The inflammation caused by these conditions affects blood flow in the tissue, resulting in swelling of the turbinates and can cause obstructed breathing. This hypertrophy can be treated both conservatively with nasal steroids and decongestants, or invasively with surgery.
There are several different methods for treatment of nasal hypertrophy of the inferior nasal turbinates, including CPT codes 30130 (excision inferior turbinate, partial or complete, any method), 30140 (submucous resection inferior turbinate, partial or complete, any method), 30801 (ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method, superficial), and 30802 (ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method, intramural), (i.e. submucosal).
An inferior turbinate resection codes to 30130 when it involves incision into the mucosa and removal of part or the entire inferior nasal turbinate, with the appropriate modifier of RT, LT or 50. In this procedure fracture of the bony turbinate away from the lateral nasal wall is included in the code, and the turbinate is excised through a mucosal incision. This procedure is commonly performed for those with severe obstruction.
An inferior turbinate resection codes to CPT 30140 when it involves submucous resection, with the appropriate modifier of RT, LT or 50. In this procedure the provider removes a part or all of the inferior turbinate bone, “saves” or preserves the mucosa, and resects the submucosal tissue and bony turbinate. Documentation must show that the provider incised the mucosa and resected the inferior turbinate submucosally to support this code. Commonly providers will also perform outfracture (CPT 30930) in combination with the submucosal resection because it has been shown to improve long-term results, but per our CCI edits we cannot code it separately when both are performed on the same side. Refer to CPT Assistant, May 2003, Volume 05, Issue 13, pages 5-6 for more information.
Another treatment of inferior turbinate hypertrophy is ablation, which is reported with codes 30801 or 30802. This involves electrocautery, radiofrequency ablation or tissue volume reduction. This method treats the soft tissue, rather than the bony structure of the turbinate. Electrocautery destroys tissue with an electrical current and radiofrequency ablation uses radio waves to destroy tissue. Excessive or mucosal hypertrophy is ablated or cauterized and may be excised. CPT 30801 is for superficial tissue, and 30802 is used for intramural, or deep in the mucosa.
REFERENCES: CPT Professional, Coders’ Desk Reference, CPT Assistant