Nasal Septal Graft Bundling

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June 12, 2014

Question: 

My physician did a septoplasty and also harvested a graft from the septum for repair of nasal vestibular stenosis. I billed CPT 30465 (nasal vestibular stenosis repair), 30520 (septoplasty) and 20912 for the septal graft. Insurance denied the graft code as bundled. I tried to appeal this and was denied. Shouldn’t this be paid because the physician did the work of harvesting the graft in addition to the septoplasty?

Answer:

We appreciate your question! Although your physician did do the work of harvesting a septal graft, any grafts taken from the same surgical field are not separately billable. A separate incision is required to bill a graft harvest in addition to a primary procedure for most codes. Some codes actually include harvesting the graft in the work of performing the primary procedure, so depending on where the graft is harvested from and primary procedure performed you may or may not be able to bill separately for the graft harvest. For instance, if your physician was performing a nasal valve reconstruction and needed a septal graft but did not do a septoplasty, the graft harvest would be separately reportable because a separate incision was made to harvest the graft from the nasal septum.