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Coding tip: Understand functional rhinoplasty procedures

Ambulatory Surgery Reimbursement Update, December 18, 2007

Base correct reimbursement for functional rhinoplasty procedures on proper coding and documentation of the medical necessity of the procedure. Be persistent and perform appeals on denied claims, if the claim is denied inappropriately (e.g., Medicare denies the claim for cosmetic reasons, when the physician performed the procedure for functional purposes (i.e., to treat restricted airflow). Documentation for functional rhinoplasty should include the following:

• State why the procedure was medically necessary
• Clearly reflect the medical problem(s) in the patient's history
• Address the patency of the nasal passages
• State the degree of obstruction

For rhinoplasty procedures, use code 30400 for a first procedure for the problem (stated as primary in the CPT Manual) of the lateral and alar cartilages and/or elevation of the nasal tip. Use code 30410 for a rhinoplasty, primary, complete, external parts, including bony pyramid, lateral and alar cartilages, and/or elevation of the nasal tip. You can bill separately for obtaining the grafts for placement in rhinoplasty procedures. Code based on where the graft was harvested. Use code 20900 for the harvesting of bone grafts. Use code 20910 for costochondral cartilage grafts, and code 20912 for nasal septum grafts. If you obtain the graft from the nasal septum to repair the septum or in a rhinoplasty procedure, you would not bill it separately.

For rhinoplasty procedures performed with septoplasty procedures, if there is medical necessity for both procedures, you can bill joint code 30420. If there is medical necessity for the septoplasty, but the surgeon performs the rhinoplasty as a cosmetic procedure (a "nose job," where the patient is self-paying for the rhinoplasty procedure), code the appropriate rhinoplasty code for the cash portion billing to the patient, and submit CPT code 30520 (septoplasty) to the insurance company as usual.

This tip is brought to you by Ellis Medical Consulting, Inc.

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