Dr. Setzen agreed that this is his coding approach. “If you’re only going to do soft tissue shrinkage via RF coblation, I use 30801 or in some cases 30802,” he said.

In addition the requirements do not apply to certain specific products such as keys and locks, the tips of writing instruments, musical instruments and crystal glass.

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As previously announced in Insight No. 826, from 1 June 2016, lead is restricted in consumer products supplied to the public in the EU under Entry 63 of Annex XVII of REACH. The total content limit of lead of 0.05% is applied to articles and accessible parts that can be mouthed by children (it is considered that an article or accessible part of an article may be placed in the mouth by children if it is smaller than 5 centimetres in one dimension or has a detachable or protruding part of that size).

Filed Under: Departments, Practice Focus, Rhinology, Special Reports Tagged With: Coding, inferior turbinate hypertrophy, Inferior Turbinate Surgery, otolaryngologist, reimbursementIssue: November 2013

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3 Don’t let coding dictate surgical choice. Dr. Setzen noted that codes 30801 and 30802 are reimbursed at a lower level than 30140, reflecting the less extensive nature of procedures that involve only soft tissue shrinkage. “But, remember, the reimbursement level should never drive physician choice in what procedure to perform, and neither should the technology,” he stressed. “You should base the procedure on your expertise, the needs of the patient and the best level of evidence.”

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4 Avoid turbinate tunnel vision. The same endoscopic and video-documenting equipment used in ITH surgery can be employed in a wide variety of functional endoscopic sinus surgery (FESS) procedures. Therefore, it’s important to focus on proper coding in all of those cases. Becker’s ASC Review contains numerous tips for accurate FESS coding. According to the website, one of the most basic FESS coding requirements is probably the most obvious, yet it is often overlooked—the need to use the codes only when an endoscope is actually used. As obvious as that sounds, the site notes that many audited practices have been penalized when it was determined that FESS codes were submitted even though the sinus surgery was done using Caldwell-Luc antrostomies or frontal sinusotomies and not by endoscopy. “There are separate codes for non-endoscopic access to all sinuses (see the 310XX and 312XX series),” the website states.

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However all such decisions should be taken on a case-by-case basis. For example the handles on kitchen furniture may be outside the scope if they are on wall units but within scope if they are on drawer units within reach of a child.

The limit does not apply where it can be demonstrated that the rate of lead release does not exceed 0.05 μg/cm2 per hour (equivalent to 0.05 μg/g/h), and, for coated articles, that the coating is sufficient to ensure that this release rate is not exceeded for a period of at least two years of normal or reasonably foreseeable conditions of use of the article. However official methods are not currently available to determine lead release.

It provides a flowchart to help decide if items are within the scope of the restriction and provides examples of articles that are within the scope on the basis they may be mouthed by children under normal or reasonably foreseeable conditions of use. These include clothing, footwear, sports and leisure items, stationery items, accessories, interior decorative items and childcare articles. It also gives examples of articles that are considered to be outside the scope of the restrictions such as fixed furnishings, fishing rods and weights, internal hinge mechanisms on frames, ski equipment and certain miniatures and models for adult collectors.

When performing office-based surgery to correct inferior turbinate hypertrophy (ITH), success doesn’t just depend on clinical outcomes. Getting adequately reimbursed for these procedures to maintain a financially stable practice is also key, and the way to accomplish that is to brush up on your knowledge of Current Procedural Terminology (CPT) codes. So here are a few tips for ensuring proper coding of procedures and maximizing reimbursement.

1 Match the correct procedure with the correct CPT code. “In concept, at least, this is very simple: If you don’t assign the right CPT code to the right procedure, your payment claim is going to be denied,” said Dr. Setzen. “But the devil is in the details.” He noted, for example, that “if you remove the soft tissue of the turbinate via the submucosal approach, use CPT code 30140, no matter what method you use,” he said. “You can use a microdebrider, or you can simply resect tissue with any instrumentation, provided this is done submucosally.”

Becker’s ASC Review, an online source on business issues affecting physicians, notes that when the submucosal approach is not used, a different CPT code is required. For example, when radiofrequency (RF) coblation alone is used to reduce the inferior turbinates, code 30802—“cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral, any method; intramural,” in CPT terminology—should be assigned and submitted for reimbursement.

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2 Don’t confuse inferior with middle turbinate surgery. 
“Turbinate surgery codes 30130, 30140 and 30930 are specific to the inferior turbinates and should not be coded for procedures performed on the middle turbinates,” Becker’s ASC Review notes. In cases where resection and some type of fracture of the middle turbinates are done, surgeons should code 30999.