September 21, 2017
I billed 30465 for an injection of a bioabsorbable implant into the lateral nasal wall to repair nasal vestibular stenosis. The insurance company is denying this for “coding issue” and “wrong place of service”. How can I appeal?
CPT 30465 says “Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal wall reconstruction)” and was introduced into CPT in 2001 – 16 years ago – which is long before the injection procedure was performed. As a point of history, the code was valued to be a hospital/ASC services, has a 90-day global period, is inherently a bilateral procedure (meaning performed on both sides so modifier 50 may not be used), requires incisions and includes grafting as well as medial osteotomies when performed. Medicare’s physician time table says the code is valued for a median intra-service time of 120 minutes. We do not recommend using 30465 for the office procedure you describe. Rather, we recommend using an unlisted CPT code such as 30999.
*This response is based on the best information available as of 09/21/17.