Procedure Code 30140, 30802, 30930
procedure code 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
procedure code 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.
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.
30802 - Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg. electrocautery, radiofrequency ablation, or tissue volume reduction), intramural (ie. submucosal)
30140 - Submucous resection inferior turbinate, partial or complete, any method
30930 - Fracture nasal inferior turbinate(s), therapeutic
AMBULATORY SURGERY CENTER CODING AND PAYMENT
Medicare payment for procedures performed in an ASC are based on the APC methodology for hospital outpatient payment. CPT codes 30802 and 30930 are designated as ASC Covered Surgical Procedures for CY 2015.
30802 - Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg. electrocautery, radiofrequency ablation, or tissue volume reduction), intramural (ie. submucosal)
30140 - Submucous resection inferior turbinate, partial or complete, any method
30930 - Fracture nasal inferior turbinate(s), therapeutic
30930 and 30140
Question:
Our surgeon wants to report CPT code 30930 every time he does an turbinate outfracture with his submucous resections (30140).I have explained that the outfracture is included but he disagrees. I talked to a peer in another practice and he told me that I can’t report it because there is a CCI edit in place.We code according to CPT rules, not Medicare payment rules, thus I would never use that as rationale in explaining to the surgeon why a code set is reportable together or not. Can KZA help with an explanation?
Answer:
Great question and thanks for reaching out to the Otolaryngology Coding Team. We checked with the team and our response follows.
In 2006, CPT revised the definition of CPT code of theturbinate codes to identify surgical procedures on the inferior turbinates only.
According to a citation in the CPT Changes: An Insider’s View, “CPT codes 30130, 30140, 30801, 30802, and 30930 have been revised to clarify their widespread usage specific to the inferior turbinates and primary reporting for procedures performed for the treatment of inferior turbinate hypertrophy causing nasal airway obstruction and to eliminate frequent confusion with middle and superior turbinates when other intra-nasal surgeries (e.g., endoscopic sinus surgery) are performed.
”Additionally, codes 30801, 30802, and 30930 were revised with the removal of “separate procedure” from the descriptors.
Cross-references were added in support of these revisions to indicate codes 30130 (partial or complete excision of turbinate bone) and 30140 (partial or complete submucous resection of turbinate bone), which report larger procedures for which removal of the inferior turbinates are inherent, would not be appropriately reported in conjunction with these codes.
” As a result of this rule change when the codes were revised to specifically address surgery on the “inferior” turbinates, the procedures became inclusive to each other.
Finally, the CPT guidelines listed directly underneath 30930 state “(Do not report 30801, 30802, 30930 in conjunction with 30130 or 30140)”.
Therefore, it is not appropriate to report 30930 with 30140 ever for procedures on the same turbinate. Just because there is a Medicare CCI column edit of “1” doesn’t mean it is appropriate to report both codes. You must understand CPT coding rules first.
Coding Guidelines
Treatment of Obstructive Sleep Apnea, B2002.13 R3
1. Oral appliances for obstructive sleep apnea must be billed to the appropriate DMERC using E1399.
2. Submucous radlofrequency reduction of hypertrophied turbinates should be Billed with CPT code 30140-30152.
3. If LAUP is billed for denial purposes, it should be coded as 42299, (unlisted procedure, palate, uvula) with "LAUP" listed in Item 19 on the CMS-1500 claim form or electronic equivalent. The claim will then be appropriately denied as not proven effective.
4. If SomnoplastyTM is billed for denial purposes, it should be coded as 42299, (unlisted procedure, palate, uvula) with "SomnoplastyTMII listed in Item 19 on the CMS-1500 claim form or electronic equivalent. This claim will then be appropriately denied as not proven effective.
5. The Pillar ProcedureTM should be billed as 42299 (unlisted procedure, palate, uvula) with "Pillar ProcedureTM" or "palatal implant" listed in Item 19 on the CMS-1500 claim form or electronic equivalent. This claim will then be appropriately denied as not proven effective.
