Septoplasty

CPT 30520
Approach Endoscopic
Add-on / Variant CPTs
  • 30140 — Submucous resection of inferior turbinate
  • 30130 — Excision of inferior turbinate, partial
  • 30801 — Ablation, inferior turbinate
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
Patient supine. Nasal decongestion with oxymetazoline-soaked pledgets.

Indications:

Patient presents with [chronic nasal obstruction / recurrent sinusitis / epistaxis] secondary to nasal septal deviation to the [right / left] [anteriorly / posteriorly]. [Nasal endoscopy confirmed septal deviation with [turbinate hypertrophy].] Conservative management with [intranasal steroids / antihistamines] failed. Functional improvement expected with septoplasty. Risks including septal perforation, saddle-nose deformity, cerebrospinal fluid leak (rare), 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 and bilateral topical cocaine [or 4% lidocaine with 1:1000 epinephrine] application. Local injection of [1% lidocaine with 1:100,000 epinephrine] performed along the anterior septum.
A hemitransfixion or Killian incision was made on the [left] side of the caudal septum. 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. Posteriorly, the perpendicular plate of the ethmoid and/or vomer were removed with [Jansen-Middleton rongeur / backbiting forceps] as needed.
The flaps were repositioned and the incision closed with [quilting sutures of 4-0 chromic / mattress sutures].
[Inferior turbinate reduction:] Bilateral inferior turbinate outfracture performed. [Submucosal resection / radiofrequency ablation] performed bilaterally to reduce turbinate volume.
[Bilateral Doyle splints or Merocel packing placed / 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 failed. Risks including 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 and bilateral topical 4% lidocaine with epinephrine. Local injection of 1% lidocaine with 1:100,000 epinephrine along anterior septum. A hemitransfixion incision was made on the left caudal septum. The mucoperichondrium was elevated bilaterally in the subperichondrial plane. The deflected cartilage and bone were identified. Deviated cartilage incised; [cartilage / bone] removed and reshaped to straighten the septum. Perpendicular plate of the ethmoid and vomer resected as needed with Jansen-Middleton rongeur. The L-strut (1 cm dorsal and caudal) was preserved. Flaps repositioned; incision closed with quilting 4-0 chromic sutures. [Inferior turbinate reduction: bilateral outfracture with submucosal resection / radiofrequency ablation.] [Doyle silicone splints / 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

Add CPT 30140 (submucous resection) or 30801 (ablation). Document bilateral vs. unilateral and technique used.

Rhinoplasty combined (septorhinoplasty)

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

Endoscopic repair of septal perforation

CPT 30630. Document perforation size, bilateral flap elevation, and interpositional graft material.

Charting Tips
  • Document deviation location (anterior, posterior, caudal). This drives the surgical approach.
  • State whether the L-strut (1 cm dorsal and caudal) was preserved. This is critical for structural support.
  • Document amount of cartilage/bone removed or resected
  • Turbinate reduction: state technique (outfracture, submucosal resection, ablation)
  • Note packing or splint placement and planned removal date
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: 30130 (partial turbinectomy, 4.48 wRVU) or 30140 (submucous resection of turbinate, 5.12 wRVU) with modifier -51.
  • 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 the surgical fee. Postoperative nasal steroid prescriptions are pharmacy charges.
  • For FESS combined with septoplasty, bill both 30520 and the appropriate FESS codes (31254-31288) with modifier -51 on secondary procedures. Document each component of the combined case separately.