CPT 42160 for Laser Ablation of a Soft Palate Papilloma

Question:

Can CPT code 42160 be used for a laser ablation of the velum surface of the soft palate papilloma (ie. is the laser considered thermal)?

Answer:

CPT 42160 is reported based on destruction of the lesion. If the documentation supports destruction of a soft palate papilloma, laser ablation qualifies as a thermal technique and meets the criteria for the code.

*This response is based on the best information available as of 03/05/26.

Reporting Rhinoplasty with Septal Repair

Question:

Our physician frequently performs septorhinoplasty procedures to address severe septal deviation and, in some cases, nasal valve collapse. He typically bills CPT 30420, which includes major septal repair. However, we are seeking clarification due to conflicting references: the Coders’ Desk Reference describes 30420 as involving nasal bone fracture and repositioning, and other sources suggest it is primarily a cosmetic procedure. Given that our physician’s intent is functional, improving airway obstruction, does CPT 30420 still apply? Is reshaping of the nasal tip or dorsal hump required to justify 30420, or would CPT 30520 (septoplasty) be more appropriate in these cases?

Answer:

The Coders’ Desk Reference includes an introductory disclaimer stating that each procedural description represents one possible method of performing the service and should not be interpreted as the only acceptable approach. Its narrative examples are intended to illustrate common surgical techniques, not to define the required components of the CPT code itself. If both a rhinoplasty and septoplasty are performed, report 30420 to capture the combined procedure, as this code includes major septal repair. Ensure that the appropriate functional or reconstructive diagnosis is reported on the claim to support medical necessity.

*This response is based on the best information available as of 02/05/26.

Sigmoid Sinus Resurfacing During Mastoidectomy

Question:

I have an ENT provider that performed a Mastoidectomy (69502) with sigmoid sinus resurfacing for pulsatile tinnitus. What CPT would I use for the sigmoid sinus resurfacing using bone cement and dust?

Answer:

A standard cortical mastoidectomy includes exposure and skeletonization of the sigmoid sinus. When additional work is performed to resurface or reconstruct a dehiscent sigmoid sinus for pulsatile tinnitus, this typically represents increased complexity of the mastoidectomy and is best reported with modifier 22 appended to CPT 69502 (or 69601 for revision cases). Because CPT does not provide a specific code for sigmoid sinus resurfacing and the work is performed through the mastoid, an unlisted code may need to be used in situations where the operative work is extensive and cannot be reasonably captured with modifier 22. Bone dust or bone pate obtained incidentally from mastoid drilling is considered local bone and is included when no separate donor incision is made. Bone cement is reported by the facility using the appropriate HCPCS supply code and is not separately reported by the physician.

*This response is based on the best information available as of 01/22/26.

Modifier for Postoperative Endoscopic Sinus Debridement

Question:

If one of our physicians performs a septoplasty and sinus surgery and then the patient comes in the office for a 31237 (endoscopic sinus debridement), would we use a modifier 79 (unrelated procedure in a global period) or 58 (staged/anticipated procedure in a global)?

Answer:

The debridement should be considered unrelated to the septoplasty because septoplasty does not routinely require postoperative debridement. Therefore, modifier 79 should be appended to 31237 when the service occurs within the septoplasty’s global period.

Ensure that diagnosis codes are properly linked to the indication for the sinus surgery and the 31237. If 31237 is linked to the septoplasty diagnosis, the payer system will interpret the procedure as related to a 90-day global and may cause a denial.

*This response is based on the best information available as of 01/08/26.

Use of 15740 for Closure Following Pituitary Tumor Excision

Question:

My physician performed a pituitary tumor excision and reported CPT code 62165-62. The ENT surgeon also performs a pedicled flap (15740). The neurosurgeon performs a fat graft for the closure. Can 15740 also be billed for the ENT surgeon, and if so, would a 59 modifier be needed?

Answer:

In skull base cases, when the ENT harvests a nasoseptal flap to repair or prevent a cerebrospinal fluid (CSF) leak during an endoscopic pituitary excision, this work is considered part of the procedure. According to CPT Assistant (December 2017, page 14), closure of a CSF leak—including the use of a nasoseptal flap—is included in the work described by 62165 and should not be separately reported. Therefore, 15740 would not be separately billable in this scenario, and modifier 59 would not apply.

*This response is based on the best information available as of 12/18/25.

Bundling of Drug-Induced Sleep Endoscopy and Turbinate Procedures

Question:

Can you explain why the sleep endoscopy 42975 and any turbinate procedure is bundled? The procedures are done for two completely different reasons—OSA and turbinate hypertrophy.

Answer:

Although CPT® 42975 and turbinate procedures (30801/30802) address distinct clinical conditions such as dynamic airway collapse in OSA versus nasal obstruction from turbinate hypertrophy, they are bundled under National Correct Coding Initiative (NCCI) edits due to shared anatomical access and procedural overlap.

Additionally, CMS coding policy states that when a diagnostic procedure leads directly to a therapeutic intervention during the same operative session, only the therapeutic procedure should be reported. The diagnostic service is considered part of the decision-making process and is not separately reimbursable.

According to CMS and NCCI guidelines, CPT® codes 30801 and 30802 cannot be separately reported when performed in the same session as other nasal or sinus procedures, including:

• For access to the nose or sinuses

• For control of intraoperative bleeding

• When performed concurrently with other nasal procedures

Importantly, modifiers such as 59 or XU are not permitted to bypass this bundling, even if the procedures are performed for separate indications. It is important to remember that turbinate hypertrophy can contribute to sleep-disordered breathing, including OSA. The coding system treats these procedures as components of a single encounter when performed together, and separate reimbursement is not allowed.

*This response is based on the best information available as of 12/04/25.