ENT- combined procedures

When performing a Nasal septoplasty 30520 and tonsillectomy 42826

some payors are reimbursing at 25% of the contracted rate siting multiple surgical procedures., even though the nasal cavity and the oropharynx are separate sites. Is that correct?

ENT - combined procedures

It's going to depend on your payor's multiple procedure payment formula. For example, Medicare would pay 100% for the 30520 (septoplasty) and 50% for the 42826 (tonsillectomy). The secondary stand-alone CPT codes are reduced for overlapping preop (you did only one preop H&P - not two) and postop periods (you evaluated both the nose and oral cavity at the same postop visit). The fact that they are different anatomical sites makes no difference here. The payor will apply their multiple procedure payment formula to all the stand-alone CPT codes.

Kim Pollock, RN, MBA, CPC
KarenZupko & Associates, Inc.
www.karenzupko.com