30130

🧬CPT Code 30130: Biopsy, intranasal

Official Descriptor

Biopsy, intranasal.

Layman Description

This procedure involves the removal of a small sample of tissue from inside the nose for pathological examination. It is typically performed to investigate abnormalities such as polyps, lesions, masses, or unexplained inflammation within the nasal cavity. The tissue is sent to a lab to determine if the cells are benign, malignant, or indicative of a specific disease process.

Code Hierarchy (Code Tree)

• Surgery
  • Respiratory System
    • Nose
      • Excision
        • 30130 (Biopsy, intranasal)

Valuation & Payment Data (2024 Medicare)

Metric	Value	Notes
Work RVU (wRVU)	1.09	Non-Facility Setting CMS 2024
Global Period	0 Days	Pre-op and post-op care not bundled; E/M may be billed separately if significant.
Assistant Payable	No	Medicare Assistant Surgeon Indicator: 2 CMS MPFS
Facility Status	Eligible	Can be performed in Office, ASC, or HOPD.
PC/TC Indicator	None	Generally a professional service code; technical component depends on setting.

Includes & Excludes

Includes

• Removal of tissue from the nasal vestibule or nasal cavity.
• Use of local anesthesia.
• Control of minor bleeding resulting directly from the biopsy site.
• Pathological specimen collection.

Excludes (Do Not Bill Separately)

• 30110: Excision, nasal polyp(s), simple (if polyp excision is the primary intent rather than biopsy).
• 30115: Excision, nasal polyp(s), complicated.
• 30118: Excision of dermoid cyst, nasal; simple.
• E/M Services: Routine pre-op/post-op care included in global period (though global is 0 days, routine decision to perform surgery is bundled). Significant, separately identifiable E/M may require modifier -25.
• Pathology: Lab processing (usually billed by lab under 88305 etc., not by surgeon).

Modifiers

Modifier	Description	Usage Context
-50	Bilateral Procedure	If biopsies are performed on both the left and right nasal cavities during the same session.
-59	Distinct Procedural Service	If performed with another procedure that is usually bundled, to indicate it was separate.
-LT	Left Side	Specifies left nasal cavity.
-RT	Right Side	Specifies right nasal cavity.
-25	Significant E/M	If a significant, separately identifiable Evaluation and Management service is performed on the same day.
-51	Multiple Procedures	If multiple distinct procedures are performed during the same session (payer dependent).

Common Associated ICD-10-CM & HCC Status

Note: HCC (Hierarchical Condition Category) status applies to the diagnosis code, not the CPT procedure. HCC affects risk adjustment scores in Medicare Advantage.

ICD-10-CM	Description	HCC Status	Risk Category
C30.0	Malignant neoplasm of nasal cavity	Yes	HCC 8 (Cancer)
D01.0	Carcinoma in situ of nasal cavity and middle ear	Yes	HCC 8 (Cancer)
J33.9	Nasal polyp, unspecified	No	N/A
J34.89	Other specified disorders of nose and nasal sinuses	No	N/A
R09.89	Other specified symptoms and signs involving the respiratory system	No	N/A
D14.0	Benign neoplasm of middle ear, nasal cavity and accessory sinuses	No	N/A

HCC Note

Only specific chronic or severe conditions (like Malignancies C30.0) carry HCC weight for risk adjustment. Simple biopsies for polyps J33.9 do not generate HCC risk scores unless the underlying condition is severe/chronic in specific plan types.

MS-DRG Information

• Outpatient: MS-DRG is not applicable for office/outpatient procedures. APC (Ambulatory Payment Classification) applies instead.
• Inpatient: If performed during an inpatient admission, the DRG is determined by the principal diagnosis.
  • Possible DRGs:
    • 056: Degenerative Nervous System Disorders (Not typical)
    • 054/055: Head & Neck Malignancy (If diagnosis is cancer C30.0)
    • 063/064: ENT Disorders (If diagnosis is benign)
  • Note: Rarely performed as a standalone inpatient procedure.

Coding Examples

Example 1: Simple Nasal Lesion

Scenario: A patient presents with a suspicious lesion on the left nasal septum. The physician performs a shave biopsy of the lesion using local anesthesia. Pathology is requested.

• CPT: 30130 (Biopsy, intranasal)
• Modifier: LT (Left side)
• ICD-10: R09.89 (Other specified symptoms… nasal mass) or D14.0 (Benign neoplasm)
• Rationale: The procedure is strictly a biopsy of intranasal tissue.

Example 2: Bilateral Polyp Biopsy

Scenario: Patient has bilateral nasal obstruction. Physician biopsies tissue from both nasal cavities to rule out malignancy before deciding on polypectomy.

• CPT: 30130
• Modifier: 50 (Bilateral) OR LT and RT (depending on payer preference)
• ICD-10: J33.9 (Nasal polyp, unspecified)
• Rationale: Biopsy performed on both sides. Modifier 50 indicates bilateral procedure.

Example 3: Biopsy with Significant E/M

Scenario: Patient comes in for new onset nosebleeds. Physician performs a detailed exam, discusses history, decides to biopsy a specific area immediately.

• CPT: 99213 (Office E/M) + 30130 (Biopsy)
• Modifier: 25 on 99213
• ICD-10: R04.0 (Epistaxis)
• Rationale: The decision to perform the biopsy was made during the visit, and the E/M service was significant and separately identifiable from the procedure itself.

Clinical Tips & Documentation Requirements

1. Site Specificity: Documentation must clearly state the location within the nose (septum, turbinate, vestibule, etc.).
2. Intent: Clearly document that the intent was diagnostic biopsy, not therapeutic excision. If the entire lesion is removed for therapy, codes like 30110 may be more appropriate.
3. Pathology: Document that the specimen was sent for permanent pathology review.
4. Anesthesia: Note the type of anesthesia used (local vs. general), though 30130 is typically local.
5. Hemostasis: Document method of hemostasis (cautery, packing, etc.) if significant.

Related Codes

• 30110: Excision, nasal polyp(s), simple
• 30115: Excision, nasal polyp(s), complicated
• 30117: Excision, nasal polyp(s), extensive
• 30120: Excision, nasal polyp(s), extensive, with lateral rhinotomy
• 30124: Excision, dermoid cyst, nasal; complicated

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Sources

^{CMS 2024 Medicare Physician Fee Schedule Final Rule AMA CPT Professional Edition 2024 CMS HCC Model 2024 Risk Adjustment Documentation ICD-10-CM Official Guidelines for Coding and Reporting}