Q: Would insertion of an absorbable nasal implant, such as Latera®, to treat nasal obstruction from valve collapse be reported with CPT code 30465, Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal wall reconstruction)?
A: No. This procedure should be reported with 30999, Unlisted procedure, nose. 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. Further instruction on how to file unlisted codes can be found here.
Published November 2017
Important Disclaimer Notice (Updated 8/7/14)
CPT for ENT articles are a collaborative effort between the Academy’s team of CPT Advisors, members of the Physician Payment Policy (3P) workgroup, and health policy staff. Articles are developed to address common coding questions received by the health policy team, as well as to clarify coding changes and correct coding principles for frequently reported ENT procedures. These articles are not intended as legal, medical, or business advice and are not a guarantee of reimbursement. The information is also not meant to serve as the definitive or sole authority on billing and coding issues. The applicability of AAO-HNS billing and coding guidance for a particular procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. You should consult with your own advisors as well as Medicare or private carriers in making any decisions about how to bill and code particular services or procedures.