July 22, 2021
We did a septoplasty and repair of nasal vestibular stenosis with spreader grafts using septal cartilage. We billed these codes: 30465, 30520 and 20912. Medicare does not bundle any of these codes. So why did we not get paid on 20912? Should we have used modifier 59 or XS on 20912 to get paid?
You were likely not paid on 20912 because harvesting of graft material obtained through the same surgical exposure/incision should not be separately reported. The septal cartilage graft was harvested when you did the septoplasty (30520) which is considered the same surgical exposure/incision. In other words, 20912 is included in 30520. Therefore, you should have only billed 30465 and 30520. Consider yourself lucky that you did not get paid on 20912 because that would have been considered an overpayment for unbundling of codes.
*This response is based on the best information available as of 07/22/21.