Coding for Concha Bullosa with other Turbinate Procedures

Q: Is it appropriate to bill for resection of a concha bullosa with other turbinate procedures?

A: Yes, under certain circumstances which require a detailed review of the operative note. It is important to remember these elements:

1. When the middle turbinate becomes pneumatized, or filled with air, the term concha bullosa is applied. CPT code 31240 (Nasal/sinus endoscopy, surgical; with concha bullosa resection) is employed for an endoscopic resection of a concha bullosa.
2. Excision of the middle turbinate without use of endoscopes is reported with 31299.
3. Excision of the middle turbinate without the presence of a concha bullosa and with endoscopic ethmoidectomy is considered integral to the endoscopic ethmoidectomy. In this case, do not report it separately.
4. CPT codes 30130 and 30140 specify the inferior turbinates.

If the surgeon performs CPT 31240 with CPT 30130 or CPT 30140 on the same (or opposite) side(s), both are billable. Modifier -59 should not be necessary but could be appended if needed to over-ride inappropriate bundles.

Many third party payers inappropriately bundle endoscopic concha bullosa resection with the turbinate excision or submucous resection codes. This occurs if the insurer does not realize that the procedures were performed on separate turbinates. These procedures are not bundled in the National Correct Coding Initiative (NCCI) edits. You should appeal denied claims for turbinate surgery when your operative notes adequately document separate procedures.

Revised April 2009