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Medical Policy: 07.01.06
Original Effective Date: January 2003
Reviewed: November 2007
Revised: June 2003
This policy applies to all products unless specific contract
limitations, exclusions or exceptions apply. Please refer to the member's coverage
manual for benefit availability. Managed care guidelines related to referral authorization,
and precertification of inpatient hospitalization, home health, home infusion and
hospice services apply.
Description:
Nasal obstruction is a common disorder. The main cause of this problem is hypertrophy of the nasal turbinates due to allergic and vasomotor rhinitis. Several surgical options are available to treat this condition. Chemical cauterization is one of them and it is generally performed under local anesthesia in a physician’s office. External application of chemical sclerosing agents are utilized to treat the turbinates. The mechanism of action using various chemical agents is not well established in the available literature. This is a controversial procedure and one that is considered investigational, therefore medical management is recommended prior to consideration of this treatment or any other surgical approach. Literature also states that repeated nasal endoscopies are considered an unproven treatment.
Policy:
Chemical cauterization of the nasal turbinates is considered investigational.
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Procedure Codes and Billing
Guidelines:
- To report provider services, use appropriate CPT* codes, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD-9 diagnostic codes.
- CPT code 30999 to bill for chemical cauterization of the nasal turbinates.
- CPT code 31231; Nasal endoscopy, performed in conjunction with chemical cauterization on the same day will also be denied.
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Selected References:
- Bhargava KB, Abhyankar US, Shah TM. Treatment of allergic and vasomotor rhinitis by the local application of silver nitrate. J Laryngol Otol 1980 Sep; 94 (9): 1025-36
- Jackson LE, Koch RJ. Controversies in the management of inferior turbinate hypertrophy: a comprehensive review. Plast. Reconstr. Surg. 103: 300, 1999
- Benton CD. Chemical cauterization of the inferior nasal turbinates. The Eye, Ear, Nose and Throat Monthly 1966; 45:90-91
- Mabry RL. Surgery of inferior turbinates: How much and when? Otolaryngology Head Neck Surgery; October 1984;92:571576.
- Rakover Y, Rosen G. A comparison of partial inferior turbinectomy and cryosurgery for hypertrophic inferior turbinates. The Journal of Laryngology and Otology August 1996;110:732-735.
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New information or technology that would be relevant for Wellmark to consider when this policy is next reviewed may be submitted to:
Wellmark Blue Cross and Blue Shield
Medical Policy Analyst
Station 304
636 Grand Ave.
Des Moines, IA 50309
*Current Procedural Terminology © 2008 American Medical Association. All Rights Reserved.
Wellmark medical policies address the complex issue
of technology assessment of new and emerging treatments, devices,
drugs, etc. They are developed to
assist in administering plan benefits and constitute neither offers of
coverage nor medical advice. Wellmark medical policies contain only a
partial, general description of plan or program benefits and do not
constitute a contract. Wellmark does not provide health care services
and, therefore, cannot guarantee any results or outcomes.
Participating providers are independent contractors in private
practice and are neither employees nor agents of Wellmark or its
affiliates. Treating providers are solely responsible for medical
advice and treatment of members. Our medical policies may be updated
and therefore are subject to change without notice.
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