Septoplasty

CPT 30520 · 6.83 wRVU · 90-day global
CPT30520
wRVU6.83
Global90-day
ApproachOpen
ComplexityModerate
Add-on / Variant CPTs
  • 30130 wRVU: 3.38 — Excision of inferior turbinate, partial or complete, any method (3.38 wRVU, 90-day global)
  • 30140 wRVU: 2.93 — Submucous resection of inferior turbinate — preserves mucosa, removes submucosal tissue/bone (2.93 wRVU, 0-day global)
  • 30801 wRVU: 1.11 — Ablation, inferior turbinate, superficial (surface cautery/mucosal ablation) (1.11 wRVU)
  • 30802 wRVU: 2.03 — Ablation, inferior turbinate, submucosal/intramural (radiofrequency, Coblator) — use for submucosal RFA, not 30801 (2.03 wRVU)
Preoperative Diagnosis:

Nasal septal deviation with nasal obstruction

Postoperative Diagnosis:

Same

Procedure Performed:

Septoplasty [with / without] inferior turbinate reduction

Attending Surgeon:

[Attending name], MD

First Assistant:

[Resident/Fellow/PA name]

Anesthesia:

General endotracheal / local with sedation

Indications:

Patient presents with chronic nasal obstruction secondary to nasal septal deviation to the [right / left] [anteriorly / posteriorly]. Nasal endoscopy confirmed septal deviation [with inferior turbinate hypertrophy]. Conservative management with intranasal steroids for [X weeks/months] failed. Functional improvement expected with septoplasty. Risks including nasal septal hematoma, septal perforation, saddle-nose deformity (from over-resection of the L-strut), and recurrence discussed. Consent obtained.

Findings:

Nasal endoscopy confirmed [C-shaped / S-shaped / anterior / posterior / caudal] septal deviation to the [right / left]. [Inferior turbinate hypertrophy bilaterally.] Nasal mucosa [intact / inflamed]. No masses or polyps.

Description of Procedure:

Nasal decongestion achieved with oxymetazoline-soaked pledgets bilaterally. [If topical cocaine used: 4% cocaine solution applied on pledgets per institutional protocol with dose documented per kg; cocaine must not be combined with epinephrine.] Local injection of 1% lidocaine with 1:100,000 epinephrine performed along the anterior septum.

A [hemitransfixion incision was made at the caudal septal edge / Killian incision was made 1-2 cm posterior to the caudal septal edge, appropriate for posterior or mid-septal deviations]. The mucoperichondrium was elevated on the [left / right] side in the subperichondrial plane, taking care to preserve the overlying mucosa. The deflected septal cartilage and bone were identified.

The deviated cartilage was incised and the contralateral mucoperichondrium elevated. [Cartilage / bone] was removed and reshaped as needed to straighten the septum. A dorsal and caudal L-strut of at least 1.0-1.5 cm was preserved. Posteriorly, the perpendicular plate of the ethmoid and/or vomer were removed with [Jansen-Middleton septum forceps / Takahashi forceps] as needed.

The flaps were repositioned. The incision was closed with [running quilting 4-0 chromic sutures to obliterate dead space / interrupted 4-0 chromic]. The septum was confirmed midline.

[Inferior turbinate reduction:] Bilateral inferior turbinate outfracture performed. [Submucous resection (30140) / submucosal radiofrequency ablation (30802) / surface cautery (30801)] performed bilaterally to reduce turbinate volume.

[Doyle silicone splints placed bilaterally / No packing.] Patient tolerated the procedure well.

Complications:

None

Specimens:

None

Estimated Blood Loss:

Minimal

Drains:

[Doyle silicone splints placed bilaterally / Merocel packing / None]

Disposition:

Patient taken to PACU in stable condition. Discharged same day.

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: Nasal septal deviation with nasal obstruction
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Septoplasty [with inferior turbinate reduction]
ATTENDING SURGEON: ***, MD/DO
FIRST ASSISTANT: ***
ANESTHESIA: General endotracheal / local with sedation

INDICATIONS: The patient is a .PTAGE-year-old .PTSEX with chronic nasal obstruction secondary to nasal septal deviation to the [right / left]. Nasal endoscopy confirmed [C-shaped / caudal / posterior] deviation [with inferior turbinate hypertrophy]. Conservative management with intranasal steroids for *** weeks/months failed. Risks including nasal septal hematoma, septal perforation, saddle-nose deformity, and recurrence were discussed. Informed consent obtained.

FINDINGS: Nasal endoscopy confirmed [C-shaped / anterior / posterior / caudal] septal deviation to the [right / left]. [Bilateral inferior turbinate hypertrophy.] No masses or polyps.

DESCRIPTION OF PROCEDURE:
Nasal decongestion achieved with oxymetazoline pledgets bilaterally. [Topical cocaine applied per protocol if used — do not combine with epinephrine.] Local injection of 1% lidocaine with 1:100,000 epinephrine along anterior septum. A [hemitransfixion / Killian] incision was made on the [left / right] [caudal septum / 1-2 cm posterior to the caudal edge]. Mucoperichondrium elevated bilaterally in the subperichondrial plane. Deflected cartilage and bone identified. Deviated cartilage incised; [cartilage / bone] removed and reshaped to straighten the septum. Perpendicular plate of the ethmoid and/or vomer resected as needed with Jansen-Middleton septum forceps. The L-strut (at least 1.0 cm dorsal and caudal) was preserved. Flaps repositioned; incision closed with running quilting 4-0 chromic sutures. [Inferior turbinate reduction: bilateral outfracture with [submucous resection (30140) / submucosal radiofrequency ablation (30802) / surface cautery (30801)].] [Doyle silicone splints placed bilaterally / No packing.] Patient tolerated the procedure well.

ESTIMATED BLOOD LOSS: Minimal
SPECIMENS: None
COMPLICATIONS: None
DRAINS: [Doyle silicone splints placed bilaterally / None]
DISPOSITION: Patient taken to PACU in stable condition. Discharged same day.

Signed: .ME, .MYDEGREE
.TODAY
Variants

With turbinate reduction

Code by technique — 30140 (submucous resection), 30801 (superficial/mucosal ablation), or 30802 (submucosal/intramural radiofrequency ablation). Do not use 30801 when submucosal RFA is performed. Document bilateral vs. unilateral and specific technique.

Rhinoplasty combined (septorhinoplasty)

Cosmetic component requires separate CPT codes. Document external vs. endonasal approach and structural grafts (spreader grafts, tip grafts).

Endoscopic-assisted septoplasty

A distinct technique using nasal endoscope for visualization, particularly for isolated posterior spurs. Document endoscope use explicitly if billing as endoscopic-assisted. Standard open/headlight septoplasty is still coded 30520 regardless of endoscope use.

Repair of septal perforation

CPT 30630 (7.11 wRVU). Document perforation size, bilateral flap elevation, and interpositional graft material.

Charting Tips
  • Document deviation location (anterior, posterior, caudal) — this drives incision choice (hemitransfixion for caudal; Killian for posterior/mid-septal). Do not call both interchangeable in the operative note.
  • State that the L-strut (at least 1.0 cm dorsal and 1.0 cm caudal) was preserved — this is critical for structural support and saddle-nose prevention. The traditional standard minimum is 1.0 cm, not 1.5 cm.
  • Document amount of cartilage/bone removed or resected
  • {'For turbinate reduction, explicitly state technique and corresponding CPT': 'outfracture alone is not separately billable; submucous resection = 30140; surface cautery = 30801; submucosal radiofrequency ablation = 30802'}
  • {'Cocaine use (if applicable)': 'document concentration, volume, and calculated dose (mg/kg). Never combine cocaine with epinephrine.'}
  • Note splint or packing placement and planned removal date. Current evidence favors Doyle splints over Merocel packing for patient comfort.
  • {'For payer medical necessity': 'document intranasal steroid failure duration (typically ≥4-6 weeks), NOSE score or equivalent symptom severity, and objective endoscopic/CT findings'}
  • Septal hematoma risk should be mentioned in informed consent documentation
Billing Tips
  • Bill 30520 for septoplasty (6.83 wRVU, 90-day global). Use for surgical correction of deviated nasal septum regardless of technique (submucous resection, cartilage scoring, spreader grafts).
  • When septoplasty is performed with inferior turbinate reduction, turbinate surgery is separately billable with modifier -59/XS to override NCCI bundling edits. Code selection by technique: 30130 (excision of inferior turbinate, partial or complete, any method, 3.38 wRVU, 90-day global); 30140 (submucous resection of inferior turbinate, 2.93 wRVU, 0-day global); 30801 (superficial mucosal ablation, e.g., surface cautery, 1.11 wRVU); 30802 (submucosal/intramural ablation, e.g., radiofrequency/Coblator, 2.03 wRVU). Document technique explicitly — 30801 and 30802 are not interchangeable.
  • Rhinoplasty (30400-30462) is a separate code from septoplasty. Septorhinoplasty bills both codes. Document functional vs. cosmetic components clearly, as cosmetic rhinoplasty is not covered by insurance and must be separated from the functional septoplasty.
  • 90-day global period: splint or packing removal, nasal saline irrigation, and routine wound checks are bundled.
  • For FESS combined with septoplasty, bill both 30520 and the appropriate FESS codes (31237-31298). Medicare processes multiple procedure payment reduction automatically — do not append modifier -51 on Medicare claims. For non-Medicare payers, check payer requirements. List the higher-wRVU code first.

General coding reference. Verify with your institution’s billing department before submitting claims.

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