30150

👩🏾‍⚕️ CPT 30150 — Rhinectomy, Partial

Official Full Descriptor

Rhinectomy; partial

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CPT 30150 captures the surgical resection of a portion of the external nose, including the skin, soft tissue, cartilaginous framework, and/or osseous components as required to achieve oncologically sound or therapeutically necessary margins. The resection is “partial” in that not all nasal structures are removed — some portion of the nose is preserved. The degree of resection ranges from a limited alar or columellar resection to a near-subtotal resection sparing only minimal nasal remnant. Reconstruction, when performed at the same operative session, is separately reportable using the appropriate wound repair, flap, or graft codes depending on technique.

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Code Classification & Position in the CPT Hierarchy

Respiratory System (10000-32999)
 └── Nose (30000-30999)
      └── Excision Procedures on the Nose (30100-30160)
           ├── 30100  Biopsy, intranasal
           ├── 30110  Excision, nasal polyp(s), simple
           ├── 30115  Excision, nasal polyp(s), extensive
           ├── 30117  Excision or destruction, intranasal lesion; internal approach
           ├── 30118  Excision or destruction, intranasal lesion; external approach
           ├── 30124  Excision, sebaceous cyst — nose; simple
           ├── 30125  Excision, sebaceous cyst — nose; complicated
           ├── 30130  Excision, inferior turbinate, partial or complete, any method
           ├── 30140  Submucous resection, inferior turbinate, partial or complete, any method
           ├── 30150  Rhinectomy; partial ← TARGET
           └── 30160  Rhinectomy; total

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Full Rhinectomy Code Pair — Partial vs. Total

These two codes are the most surgically significant codes in the nasal excision family and share a 90-day global period. Understanding the distinction is critical for accurate code selection.

CPT	Full Descriptor	Extent of Resection	wRVU (approx.)	Global Period
30150	Rhinectomy; partial	Portion of external nose removed; some nasal structure preserved	~15.11	90 days
30160	Rhinectomy; total	Entire external nose removed, including all soft tissue; may include nasal bones	~19.10	90 days

Important

Critical Distinction: The dividing line between partial and total rhinectomy is whether any functional or anatomical nasal unit is preserved after resection. If the surgeon removes the entire external nasal structure — skin envelope, lower lateral cartilages, upper lateral cartilages, cartilaginous septum as it projects externally, and overlying soft tissue — and nothing of the external nose remains, report 30160. If any portion of the external nose (e.g., one nasal ala, the dorsum, the root) remains intact and functional, report 30150. When operative documentation is ambiguous, query the surgeon.

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Broader Nose Excision & Repair Code Family — Contextual Reference

Understanding adjacent code families is essential because rhinectomy is almost always combined with reconstruction:

Excision (30100-30160)

CPT	Description
30100	Intranasal biopsy
30110	Nasal polyp excision, simple
30115	Nasal polyp excision, extensive
30117	Intranasal lesion excision/destruction, internal approach
30118	Intranasal lesion excision/destruction, external approach
30124	Sebaceous cyst excision, nose, simple
30125	Sebaceous cyst excision, nose, complicated
30150	Rhinectomy, partial
30160	Rhinectomy, total

Repair / Reconstruction (30400-30630)

CPT	Description	Common Pairing with 30150
30400	Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip	Rarely — cosmetic context
30410	Rhinoplasty, primary; complete, external parts including bony pyramid	Sometimes for staged reconstruction
30420	Rhinoplasty, primary; including major sep repair	Complex cases
30430	Rhinoplasty, secondary; minor revision (small amount of nasal tip work)	Follow-up revision
30450	Rhinoplasty, secondary; major revision	Major post-rhinectomy reconstruction
30460	Rhinoplasty for nasal deformity incl tissue graft	Reconstruction post-rhinectomy
30462	Rhinoplasty for nasal deformity; 3 or more stages	Multistage reconstruction
30620	Septal or other intranasal dermoplasty	Internal defect coverage
30630	Repair of nasal septal perforations	Perforation after partial resection

Wound Repair / Flap Codes Commonly Paired with 30150

CPT	Description
13131-13133	Complex wound repair, face/nose, 1.1-2.5 cm; 2.6-7.5 cm (per addl 5 cm)
14040-14041	Adjacent tissue transfer/rearrangement, forehead, cheeks, chin, mouth; 10 sq cm or less; 10.1-30.0 sq cm
14060-14061	Adjacent tissue transfer/rearrangement, eyelids, nose, ears, lips; 10 sq cm or less; 10.1-30.0 sq cm
15120-15121	Split-thickness autograft, face; first 100 sq cm; each additional 100 sq cm
15240-15241	Full-thickness skin graft, face; 20 sq cm or less; each additional 20 sq cm
15570-15576	Formation of direct or tubed pedicle flap
15731	Paramedian forehead flap
15732	Muscle, myocutaneous, or fasciocutaneous flap; head and neck (e.g., trapezius, SCM flap)
15740	Island pedicle flap
15760	Composite graft (e.g., skin and cartilage, skin and bone)
20912	Cartilage graft; nasal septum
20920	Cartilage graft; rib
21179-21180	Reconstruction of orbital wall; periorbital involvement if rhinectomy extends to nasal bones

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Procedure Description — What CPT 30150 Represents

Clinical Definition

CPT 30150 describes the partial surgical excision of the external nose — a complex, typically oncology-driven operation that involves removal of nasal skin, subcutaneous tissue, and varying amounts of the cartilaginous and/or bony nasal framework. The procedure is most commonly performed for malignant neoplasms of the external nose (squamous cell carcinoma, basal cell carcinoma, melanoma) or nasal cavity that have invaded or originated at the external nasal surface, or for aggressive locally recurrent tumors following previous failed treatment modalities including Mohs micrographic surgery, radiotherapy, or prior conservative excision.

Unlike a simple skin excision or Mohs repair — which involve only the superficial cutaneous layer — a partial rhinectomy by definition involves resection through the full thickness of at least one nasal subunit, including the nasal framework (cartilage or bone). When the excision is limited to the skin only without disrupting underlying cartilage, wound repair codes (13132, 14060, 15240) are used, not 30150.

Nasal Subunits and Resection Extent

The nose is divided into nine aesthetic subunits whose preservation or sacrifice determines the extent and complexity of the rhinectomy and subsequent reconstruction:

Nasal Subunit	Location	Structural Content
Dorsum	Central ridge, tip to nasion	Skin, bilateral upper lateral cartilages (partially)
Sidewalls (×2)	Lateral nose from dorsum to alar crease	Skin, upper lateral cartilage
Tip	Most projecting point	Skin, lower lateral cartilages (dome area)
Alae (×2)	Wing-shaped lateral nasal walls	Skin, alar cartilage, soft tissue
Soft triangles (×2)	Below the dome, above alar rim	Thin skin and connective tissue
Columella	Skin between nostrils	Columellar strut, medial crural cartilages

A partial rhinectomy may involve one, two, or several of these subunits. The operative report must describe which subunits were excised and what structural layers (skin only vs. skin + cartilage vs. skin + cartilage + bone) were removed to justify 30150 over less extensive codes or Mohs repair codes.

Anesthesia Requirement

CPT 30150 is performed exclusively under general endotracheal anesthesia in the operating room. The extent of resection, the need for intraoperative margin assessment (frozen sections), and the complexity of same-session or staged reconstruction all necessitate a controlled surgical environment. Local anesthesia with or without sedation is not appropriate for a procedure of this magnitude.

Intraoperative Frozen Section Margins

In oncologic rhinectomy, intraoperative frozen section margin assessment is a critical component of the procedure. Multiple margins (mucosal, deep/periosteal, and cutaneous margins) are submitted to pathology for real-time analysis during the resection. These frozen section services are billed separately by the pathology department under 88331 (initial block) and 88332 (each additional block) and are not bundled into 30150.

The 30150 Resection Continuum

The term “partial rhinectomy” encompasses a wide spectrum of surgical extents:

Limited Partial Rhinectomy: Resection of one or two nasal subunits (e.g., ala + soft triangle) involving skin + alar cartilage. Leaves the majority of the external nose intact. Commonly performed for localized alar SCC or BCC. Reconstruction may be accomplished with local flap (e.g., bilobed flap, nasolabial flap) or skin graft.

Moderate Partial Rhinectomy: Resection of three to five nasal subunits (e.g., tip + both alae + both soft triangles). Involves lower lateral cartilages and nasal tip. Requires more complex reconstruction: paramedian forehead flap or other regional flap, cartilage graft from septum or rib for framework restoration.

Near-Total Partial Rhinectomy: Resection of six to eight nasal subunits with preservation of only the nasal root and a small portion of the dorsum or sidewall. Borders on total rhinectomy territory. Complex multistage reconstruction with forehead flap, cartilage/bone grafts, and internal lining reconstruction. If all nine subunits are removed, escalate to 30160 (total rhinectomy).

Relation to Mohs Micrographic Surgery

Partial rhinectomy (30150) and Mohs micrographic surgery (17311-17315 + repair) are related but distinct. Key distinctions:

• Mohs surgery provides layer-by-layer horizontal margin control for skin cancers with peripheral/deep mapping; it may leave the nasal cartilage intact if cancer does not invade it; reconstruction after Mohs is coded separately
• 30150 (Partial Rhinectomy) is appropriate when: (a) the cancer invades cartilage or bone (below the skin layer), (b) a wide full-thickness excision is required that exceeds the scope of Mohs, (c) the procedure is performed in an OR setting with full-thickness nasal subunit resection, or (d) the reconstruction requires staged, complex tissue transfer that is inseparable from the resection
• When a Mohs surgeon performs the skin removal and an ENT/head-and-neck surgeon performs cartilage and framework resection on the same day, coding is typically Mohs (17311+) by the dermatologic surgeon with a separately reportable surgical procedure (30150) by the head-and-neck surgeon — verify with NCCI and payer guidelines for co-surgeon billing scenarios

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Includes

The following components are bundled into 30150 and cannot be separately billed at the same encounter:

• Resection of nasal skin, subcutaneous tissue, and fat within the surgical field
• Resection of nasal cartilage (alar, lower lateral, and/or upper lateral cartilages) as part of the rhinectomy
• Resection of nasal bone(s) when the excision involves the osseous dorsum or nasal root as part of the partial rhinectomy margin
• Subperiosteal dissection of the nasal bones when necessary to achieve negative margins
• Primary wound closure when closure is achieved with simple layered repair at the same site (linear repair is bundled; complex or flap repair is separately reportable — see Excludes section)
• Perioperative local anesthetic injection to the surgical site
• Placement of surgical drains at the rhinectomy site
• Post-procedure nasal dressing and packing within the 90-day global period
• Wound checks and dressing changes during the 90-day global period — separately identifiable visits outside the global are not separately billable unless a new, unrelated problem is addressed (with appropriate modifier and documentation)

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Excludes / Separately Reportable

Reconstruction — Key Separately Reportable Services

Reconstruction of the nasal defect created by 30150 is the most important billing consideration for this code. The CPT description for rhinectomy covers only the resection. Reconstruction — whether local flap, regional pedicle flap, free flap, or graft — is separately reportable with appropriate modifier documentation. This is where significant additional wRVU value is generated in rhinectomy cases.

Reconstructive Procedure	CPT Code	Notes
Adjacent tissue transfer (Z-plasty, rotation flap), nose; ≤10 sq cm	14060	Most common first-choice for small alar defects
Adjacent tissue transfer, nose; 10.1-30 sq cm	14061	Larger flap rotation
Adjacent tissue transfer, forehead/cheek	14040-14041	When cheek or forehead tissue is rotated
Complex repair, face/nose, 1.1-2.5 cm	13131	Deep layered closure, complex defect
Complex repair, face/nose, 2.6-7.5 cm	13132	Common size range for rhinectomy defects
Complex repair, each additional 5 cm	+13133	Add-on to 13132
Full-thickness skin graft, face; ≤20 sq cm	15240	FTSG for nasal defects; common in reconstruction
Full-thickness skin graft, each addl 20 sq cm	+15241	Add-on
Paramedian forehead flap	15731	Regional pedicle flap; major reconstruction
Pedicle flap, formation	15570-15576	When forehead/cheek pedicle used
Cartilage graft, nasal septum	20912	Framework reconstruction using septal cartilage
Cartilage graft, rib	20920	Major framework reconstruction
Composite graft (skin + cartilage)	15760	For through-and-through alar defects
Muscle/myocutaneous/fasciocutaneous flap, head/neck	15732	Complex regional flap reconstruction
Free flap (e.g., radial forearm free flap)	15756-15758	For major nasal/midface reconstruction

Other Separately Reportable Services

Code	Description	Why Separate
88331	Intraoperative frozen section, initial tissue block	Pathology service; not surgical
+88332	Intraoperative frozen section, each additional tissue block	Pathology add-on
21182-21184	Reconstruction of midface/orbital floor	If rhinectomy extends to midface/orbit
31020-31032	Maxillary sinusotomy	If paranasal sinus involvement requires concurrent access
30999	Unlisted procedure, nose	If reconstruction technique has no direct CPT equivalent
99213-99215 with -24	Office E&M during 90-day global for a new, unrelated problem	Must be clearly documented as unrelated to rhinectomy

Important NCCI and Bundling Notes

30150 and 30160 cannot both be reported at the same encounter. If the operative report documents what begins as a partial rhinectomy but extends to total removal of the external nose, report only 30160 (total). The more extensive code encompasses the less extensive.

Reconstruction codes are NOT automatically bundled into 30150, unlike many other surgical codes where immediate closure is included. The CPT parenthetical and AMA guidance support separate reporting of flap and graft reconstruction following rhinectomy, provided the reconstruction is separately documented as a distinct service beyond simple primary closure. This is one of the highest-value coding opportunities in ENT head and neck surgery — document reconstruction clearly and completely.

Septoplasty (30520) may be separately reportable if performed for a distinct indication (e.g., residual septal deformity causing obstruction, harvesting of cartilage with concurrent airway correction) — verify NCCI edits and append modifier -59/XS if appropriate per payer guidelines.

Neck dissection (38700, 38720, 38724) may be performed concurrently for regional lymph node management in nasal malignancy cases; these are separately reportable procedure codes representing entirely distinct surgical work.

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HCC (Hierarchical Condition Category)

Field	Detail
HCC Mapped	No — CPT 30150 is a procedure code; procedure codes do not carry HCC weight
HCC Opportunity via Diagnosis	The ICD-10-CM diagnoses driving the rhinectomy are where HCC risk adjustment is captured. Nasal malignancies (C30.0 — malignant neoplasm of nasal cavity; C44.301-C44.391 — carcinoma of nose skin) are CMS-HCC mapped. Additionally: squamous cell carcinoma of the skin of the nose (C44.311 for right; C44.321 for left; C44.391 for other), melanoma of the nasal surface (C43.31x), and invasive nasal carcinoma all carry HCC significance. When rhinectomy is performed for malignancy, always ensure the malignancy is coded to the most specific site and morphology — this is where the HCC capture occurs.
Key HCC-Adjacent Diagnoses for 30150	C30.0 (nasal cavity malignancy), C44.301-C44.391 (SCC/BCC nose), C43.31x (melanoma nose), C76.0 (malignant neoplasm head, face, neck NEC), Z85.828 (personal history of nasal malignancy)

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wRVU (Work Relative Value Units)

CPT 30150 is a low-volume, high-complexity surgical procedure. Its wRVU reflects the substantial preoperative, intraoperative, and postoperative physician work involved in a major head and neck oncologic operation with a 90-day global period.

Component	Facility Setting	Non-Facility Setting
Work RVU (wRVU)	~15.11	~15.11
Practice Expense RVU	~8.50 (facility)	~8.50 (non-facility — virtually always facility for this procedure)
Malpractice RVU	~1.20	~1.20
Total RVU (facility)	~24.81	Not clinically applicable

Important Caveat: CPT 30150 is a low-volume code that may be carrier-priced in some Medicare localities rather than having a standard national RVU value. When CMS does not have sufficient national data to value a procedure, it may assign a “by report” or carrier-priced designation, meaning the MAC (Medicare Administrative Contractor) determines the payment based on operative report review. Always verify against the current CMS MPFS Addendum B for your locality. For commercial payers, value may be negotiated or referenced against similar-complexity codes.

Approximate Medicare National Payment (Facility, 2025):

• If valued: Total RVU (~24.81) × Conversion Factor ($32.35)=approximately\ast \ast$800-$850** for the physician fee alone
• Combined with separately reportable reconstruction (e.g., paramedian forehead flap 15731, wRVU ~8.00 + cartilage graft 20912, wRVU ~3.50), total professional encounter value may reach $1,200-$1,500+

wRVU Context — Head and Neck Oncologic Procedures:

CPT	Description	wRVU (approx.)
30150	Rhinectomy, partial	~15.11
30160	Rhinectomy, total	~19.10
31360	Total laryngectomy	~22.82
38720	Radical neck dissection	~18.50
38724	Selective neck dissection	~14.50
15731	Paramedian forehead flap	~8.00
20912	Cartilage graft, nasal septum	~3.50
21120	Genioplasty; augmentation	~8.25

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Assistant Payable

Field	Detail
Medicare Assistant-at-Surgery	Yes — Payable (Indicator 1)
Medicare Indicator Definition	Indicator 1 = “Assistant at surgery may be paid, but documentation of medical necessity required”
Practical Implication	For Medicare patients, an assistant surgeon may be reimbursed when the claim is supported by documentation of medical necessity. The assistant bills with modifier -80 (assistant surgeon) or -81 (minimum assistant), and the payment is typically 16% of the primary surgeon’s allowed amount.
When Is an Assistant Medically Necessary?	For 30150, the complex nature of near-total resection, intraoperative frozen section margin management, simultaneous reconstruction with regional flaps or free flaps, and management of adjacent structures (orbit, maxilla, nasal bones) all support medical necessity for an assistant. Concurrent neck dissection (if performed) also strongly supports assistant billing.
Modifier -80	Assistant surgeon, full participation; bills 20% of the primary surgeon’s fee (Medicare pays 16% of the allowed amount after 20% patient co-pay)
Modifier -81	Minimum assistant surgeon (scrub assist); less common; same payment structure
Modifier -82	Assistant surgeon when qualified resident unavailable; used in teaching hospitals when no qualified surgical resident is available; requires documentation
Commercial Payers	Most commercial payers allow assistant billing for major oncologic head and neck procedures; verify per individual payer contract and policy
Co-Surgeon Scenario	If two surgeons of equal skill level perform the rhinectomy together (e.g., ENT and plastic surgery performing resection and reconstruction as equal co-surgeons at the same session), each bills with modifier -62 (co-surgeon) and each receives 62.5% of the global allowed amount. This is different from an assistant relationship.

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Global Period — 90 Days

CPT 30150 carries a 90-day global surgical package, the same as all major head and neck surgical procedures. This is one of the most impactful aspects of rhinectomy coding from an inpatient and practice management perspective.

What Is Included in the 90-Day Global Package

The 90-day global period begins the day before surgery (day -1) and extends 90 days following the day of surgery. During this window, the following services are bundled and cannot be separately billed by the operating surgeon:

• All pre-operative visits on the day before and day of surgery related to the operative condition
• All intra-operative services
• All post-operative visits related to recovery from rhinectomy (wound checks, suture removal, packing changes, drain management, dressing changes, flap monitoring)
• Treatment of complications that do not require return to the operating room
• Post-operative pain management related to the rhinectomy

What Is Separately Billable During the 90-Day Global Period

Scenario	Billing Action
E&M for a new, unrelated problem	Bill with modifier -24 (unrelated E&M during global period)
Return to OR for complication (e.g., flap failure, wound dehiscence requiring OR management)	Bill the return OR procedure with modifier -78 (return to OR for complication)
Staged reconstruction during global period	Bill the reconstruction CPT (e.g., 15731 pedicle division, 15732) with modifier -58 (staged procedure during global period)
Concurrent management of unrelated condition	Modifier -79 (unrelated procedure during global period)
Subsequent surgeon taking over global care	Modifier -55 (postoperative management only)
Surgery only, no global pre/post care	Modifier -54 (surgical care only)

Critical Coding Implication: Staged Reconstruction

Rhinectomy reconstruction is frequently staged, particularly when forehead flap (15731) or free flap techniques are used. The standard paramedian forehead flap involves at least two stages: (1) flap elevation and inset, and (2) pedicle division and inset 3-4 weeks later. If pedicle division occurs within the 90-day global period of the rhinectomy, it must be billed with modifier -58 by the same surgeon. This is expected and appropriate — modifier -58 signals to the payer that a staged procedure is occurring within the global period and prevents automatic denial of the claim. Without modifier -58, the claim will deny as bundled.

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Site of Service (SOS)

Setting	Applicable	Notes
Operating Room — Hospital Inpatient	Yes — most common for major cases	Complex resections, free flap reconstruction, or medically complex patients; inpatient admission expected for 1-3+ days
Operating Room — Hospital Outpatient (HOPD)	Yes — limited cases	Carefully selected patients with small resections and local flap reconstruction where outpatient discharge is feasible
Ambulatory Surgery Center (ASC)	Rarely	For highly select, limited partial rhinectomy (e.g., alar resection with small FTSG or local flap) in low-risk patients; verify ASC covered procedure list
Office	No	Not appropriate for full-thickness nasal resection requiring general anesthesia, frozen sections, and potential complex reconstruction

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MS-DRG Assignment

CPT 30150 is a surgical procedure code that functions as an OR-level procedure for MS-DRG assignment under the IPPS grouper. The MS-DRG is determined by the combination of principal diagnosis, procedure code, and CC/MCC status.

Primary DRG Assignment — Nasal/ENT Malignancy Context

When performed for malignant neoplasm of the nasal cavity, skin of the nose, or adjacent structures:

MS-DRG	Title	CC/MCC
146	Ear, Nose, Mouth and Throat Malignancy with MCC	With Major CC
147	Ear, Nose, Mouth and Throat Malignancy with CC	With CC
148	Ear, Nose, Mouth and Throat Malignancy without CC/MCC	Without

Principal Diagnoses driving 146-148:

• C30.0 — Malignant neoplasm of nasal cavity
• C44.301 / C44.311 / C44.321 / C44.391 — Squamous cell carcinoma, skin of nose
• C44.101 / C44.111 / C44.121 / C44.191 — Basal cell carcinoma, skin of nose
• C43.31x — Melanoma, skin of nose
• C76.0 — Malignant neoplasm, head, face, neck NEC
• C79.89 — Secondary malignant neoplasm, other specified sites (if metastatic)

Tracheostomy DRGs — When Combined with Airway Management

If rhinectomy is performed concurrently with tracheostomy for airway protection or combined with laryngectomy in extended head and neck oncologic cases:

MS-DRG	Title
011	Tracheostomy for Face, Mouth and Neck Diagnoses with MCC
012	Tracheostomy for Face, Mouth and Neck Diagnoses with CC
013	Tracheostomy for Face, Mouth and Neck Diagnoses without CC/MCC

Surgical Repair / Other OR Procedure DRGs — Non-Malignant Context

When rhinectomy is performed for non-malignant disease (severe trauma, invasive fungal infection, radionecrosis):

MS-DRG	Title	Context
579	Other Ear, Nose, Mouth and Throat OR Procedures with MCC	Non-malignant OR procedure
580	Other Ear, Nose, Mouth and Throat OR Procedures with CC
581	Other Ear, Nose, Mouth and Throat OR Procedures without CC/MCC

Relative Weight Considerations

ENT malignancy DRGs (146-148) carry the following approximate relative weights (FY2025):

• DRG 146 (with MCC): ~2.80-3.20 relative weight
• DRG 147 (with CC): ~1.80-2.10 relative weight
• DRG 148 (without CC/MCC): ~1.20-1.40 relative weight

CC/MCC secondary diagnoses that commonly accompany rhinectomy for malignancy and drive DRG tier elevation include: C77.0 (secondary malignant neoplasm of lymph nodes of head/neck — MCC), E11.649 (T2DM with hypoglycemia without coma — CC), N18.3-N18.4 (CKD — CC/MCC), I50.9 (heart failure — CC/MCC), J96.00 (acute respiratory failure — MCC), and anticoagulation or bleeding disorders.

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Commonly Paired ICD-10-CM Diagnosis Codes

Always code to the highest degree of specificity. Laterality and morphology specificity directly affect HCC capture and DRG tier.

Primary Malignant Neoplasms of the Nose and Nasal Cavity

ICD-10-CM	Description	HCC
C30.0	Malignant neoplasm of nasal cavity	Yes
C30.1	Malignant neoplasm of middle ear	Yes
C31.0	Malignant neoplasm of maxillary sinus	Yes
C31.1	Malignant neoplasm of ethmoidal sinus	Yes

Skin Malignancies of the Nose (External Surface)

ICD-10-CM	Description	HCC
C44.301	Unspecified malignant neoplasm, skin of nose	Yes
C44.311	Basal cell carcinoma, skin of nose	Yes
C44.321	Squamous cell carcinoma, skin of nose	Yes
C44.391	Other specified malignant neoplasm, skin of nose	Yes
C43.31	Malignant melanoma of nose	Yes
C43.311	Malignant melanoma of right side of nose	Yes
C43.312	Malignant melanoma of left side of nose	Yes

Benign and In Situ Conditions Requiring Rhinectomy (Less Common)

ICD-10-CM	Description
D02.3	Carcinoma in situ, other respiratory organs (nasal cavity)
D14.0	Benign neoplasm of middle ear, nasal cavity, accessory sinuses
D10.7	Benign neoplasm of hypopharynx

Non-Neoplastic Conditions Requiring Rhinectomy

ICD-10-CM	Description
B44.1	Other pulmonary aspergillosis (invasive fungal rhinosinusitis extending to nasal structures)
B46.1	Rhinocerebral mucormycosis — invasive fungal infection requiring tissue debridement/rhinectomy
M31.3	Wegener’s granulomatosis with renal involvement (GPA) — saddle nose deformity, tissue necrosis
M31.31	Granulomatosis with polyangiitis (GPA) with renal involvement
S09.90XA	Unspecified injury of head, initial encounter (traumatic avulsion/amputation of nose)
T22.352A	Burn of third degree, nose (severe burn requiring rhinectomy)
L97.509	Non-pressure chronic ulcer of skin of other site (rare radiation necrosis)

Secondary Neoplasms / Metastatic Disease

ICD-10-CM	Description	HCC
C77.0	Secondary malignant neoplasm of lymph nodes, head/neck	Yes (MCC)
C79.89	Secondary malignant neoplasm, other specified sites	Yes
Z85.118	Personal history of malignant neoplasm of other respiratory organs	—
Z85.828	Personal history of other malignant neoplasm of skin	—

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Present on Admission (POA)

CPT 30150 is a procedure code — POA indicators are assigned to ICD-10-CM diagnosis codes, not procedure codes. For the inpatient admission associated with rhinectomy:

• Principal diagnosis (e.g., C30.0, C44.311): POA = Y — the malignancy prompting the procedure is almost universally present on admission
• Comorbidities — assign POA per documentation and clinical timeline
• Complications arising during rhinectomy or recovery — these will be POA = N and must be coded separately per complication guidelines

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Coding Guidelines, Rules & Common Errors

Rule 1 — Confirm Full-Thickness Resection Through Nasal Framework

CPT 30150 requires resection through and including nasal cartilage and/or bone, not skin excision only. If the operative note documents skin-only excision of a nasal tumor without disruption of the underlying cartilaginous or osseous framework, report a wound excision code (11640-11646 — excision of malignant lesion, face/nose by size) or a Mohs code (17311+) rather than 30150. 30150 is justified only when the nasal framework (cartilage or bone) is surgically violated as part of the planned resection.

Rule 2 — Partial vs. Total: What Remains?

If the operative note documents that “all external nasal structures were removed” or “the entire nose was amputated,” report 30160 (total rhinectomy), not 30150. If any nasal subunit — even the nasal root and proximal dorsum — is preserved, 30150 applies. When the operative note is ambiguous on what was preserved vs. resected, query the surgeon before assigning either code. Never upcode from 30150 to 30160 without explicit documentation of total removal.

Rule 3 — Bill Reconstruction Separately and Completely

This is the single largest revenue capture opportunity in rhinectomy coding. Reconstruction is not bundled into 30150. Every identifiable reconstructive technique — adjacent tissue transfer, FTSG, forehead flap elevation, pedicle division, cartilage graft harvest — should be separately reported with its own CPT code. The operative report should describe each reconstructive maneuver distinctly. Failure to capture reconstruction codes results in substantial lost professional revenue.

Rule 4 — Staged Reconstruction = Modifier -58, Not -78

When pedicle division (the second stage of a forehead flap) or other staged reconstruction is performed within the 90-day global period of 30150, it must be billed with modifier -58 (staged or related procedure). Do not use -78 (return for complication) for a planned staged procedure. Modifier -78 is only for unplanned returns to the OR due to a complication of the original surgery. Using -78 on a planned staged reconstruction is a modifier misuse error and may trigger an audit.

Rule 5 — The 90-Day Global Trap: Packing Changes and Wound Checks

During the 90-day global period, post-operative wound management by the operating surgeon is bundled. Office visits for dressing changes, suture removal, flap monitoring, and routine wound checks cannot be separately billed by the operating surgeon within the global period. If a new, unrelated problem is addressed at the same visit, bill that separately with modifier -24. If a post-operative complication requiring new and significant care (but not OR return) arises, documentation must clearly support that the services exceed routine post-op care.

Rule 6 — Modifier -22 for Extraordinary Work

When the surgical complexity of the rhinectomy substantially exceeds what is typical for CPT 30150 (e.g., extensive bony resection requiring partial maxillectomy, orbital floor dissection, or involvement of the anterior skull base requiring neurosurgical assistance), modifier -22 (increased procedural services) may be appended. Supporting documentation should include a separate written justification detailing the extraordinary nature of the work. Most payers require an operative note review and will reimburse an additional 15-25% of the allowed amount if the modifier is supported.

Rule 7 — Concurrent Neck Dissection Is Separately Reportable

Elective or therapeutic neck dissection performed at the same session as 30150 for lymph node staging or therapeutic management of regional disease is a completely separate, additionally reportable service. Code the neck dissection (38700, 38720, 38724) in addition to 30150 — these are distinct anatomical regions and procedures. Apply modifier -51 (multiple procedures) per payer requirements. The surgeon performs two distinct major operations; both should be captured.

Rule 8 — Free Flap Reconstruction with 30150

When rhinectomy is combined with free flap reconstruction (e.g., radial forearm free flap, anterolateral thigh flap) performed by a plastic surgeon, co-surgeon billing (modifier -62) may be appropriate if both surgeons contribute equally to the resection and reconstruction as co-equal surgical participants. Alternatively, if one surgeon performs the rhinectomy (30150) and a second performs the free flap (15756-15758) as separately distinct components, each bills their own primary code without co-surgeon modifier. Document clearly in both operative notes which surgeon performed which specific components.

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Anesthesia Codes Associated with CPT 30150

CPT	Description	Base Units (approx.)
00160	Anesthesia for procedures on nose and accessory sinuses; not otherwise specified	5
00162	Anesthesia for procedures on nose and accessory sinuses; radical surgery	8

Tip

00162 (radical surgery) is the most appropriate anesthesia crosswalk for 30150 given its oncologic and major surgical nature. Anesthesiologists bill separately for their services using the anesthesia time-based formula (base units + time units × conversion factor). This is entirely distinct from 30150 and is not a component of the surgical fee.

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Coding Examples

Example 1 — Partial Rhinectomy for Alar SCC with Local Flap Reconstruction

A 74-year-old male with a well-differentiated squamous cell carcinoma of the right nasal ala is taken to the OR. Frozen section-guided resection is performed: the right alar subunit (skin + alar cartilage) is excised with 6 mm margins. All margins are confirmed negative by intraoperative frozen sections (×3 blocks submitted). A bilobed rotation flap from the right nasal sidewall and cheek is elevated and inset to close the defect (14 sq cm flap area). The patient is admitted overnight for observation.

CPT: 30150 — Rhinectomy, partial CPT: 14061 — Adjacent tissue transfer/rearrangement, nose; 10.1-30.0 sq cm CPT: 88331 — Frozen section, initial tissue block (billed by pathology) CPT: +88332× 2 — Additional frozen section blocks (billed by pathology) ICD-10-CM: C44.321 — Squamous cell carcinoma, skin of nose, right side MS-DRG: 147 or 148 depending on secondary diagnoses and CC status Global Period: 90 days begins from date of surgery

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Example 2 — Partial Rhinectomy with Paramedian Forehead Flap — Stage 1

A 68-year-old woman with a large BCC involving the nasal tip and bilateral soft triangles (three nasal subunits) is taken to the OR. Frozen section-guided resection removes the nasal tip subunit and bilateral soft triangles with clear margins. Lower lateral cartilages and the domes are partially resected. The defect (3.5 × 3.0 cm) requires major reconstruction. A left paramedian forehead flap is elevated based on the supratrochlear artery, inset into the nasal defect, and the pedicle left intact pending stage 2 pedicle division in 3-4 weeks.

CPT: 30150 — Rhinectomy, partial (stage 1 resection) CPT: 15731 — Paramedian forehead flap (stage 1 — flap elevation and inset) ICD-10-CM: C44.311 — Basal cell carcinoma, skin of nose Note: Stage 2 (pedicle division, typically CPT 15732 or 15731-58) will be billed within the 90-day global period with modifier -58

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Example 3 — Stage 2 Pedicle Division Within Global Period

Three weeks following the partial rhinectomy and forehead flap placement (Example 2 above), the patient returns to the OR for pedicle division and final flap inset.

CPT: 15731-58 or 15732-58 — Pedicle division, staged procedure within global period ICD-10-CM: C44.311 — BCC nose (same diagnosis) Modifier -58: Mandatory — signals staged procedure during global period; prevents denial as “bundled” Do NOT use -78: Modifier -78 is for unplanned return due to complications, not planned staged surgery

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Example 4 — Partial Rhinectomy with Cartilage Graft and FTSG

A 58-year-old male presents with an alar rim defect from SCC invading the right ala and crus. Right alar and columellar subunits are resected. Cartilage graft from the nasal septum is harvested to reconstruct the alar rim framework. A full-thickness skin graft (1.5 × 2.0 cm = 3 sq cm, from preauricular donor site) is applied over the cartilage framework to reconstruct the nasal skin envelope.

CPT: 30150 — Rhinectomy, partial CPT: 20912 — Cartilage graft, nasal septum CPT: 15240 — Full-thickness skin graft, face; ≤20 sq cm ICD-10-CM: C44.321 — SCC skin of nose, right side Note: Reconstruction codes (20912 and 15240) are separately reportable — not bundled into 30150

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Example 5 — Rhinectomy for Invasive Fungal Infection (Mucormycosis)

A 52-year-old immunosuppressed male (post-renal transplant) developsrhinocerebral mucormycosiswith skin necrosis and invasion of the left nasal ala and lateral wall. Emergency debridement and partial rhinectomy are performed, removing the left alar and sidewall subunits. Reconstruction is deferred pending stabilization and clearance of infection. Antifungal therapy is initiated.

CPT: 30150 — Rhinectomy, partial (emergent debridement in OR) ICD-10-CM (Principal): B46.1 — Rhinocerebral mucormycosis ICD-10-CM (Secondary): Z94.0 — Kidney transplant status ICD-10-CM (Secondary): D89.813 — Graft-versus-host disease (if applicable) or T86.12 — Kidney transplant failure MS-DRG: Will be driven by mucormycosis (B46.1) principal diagnosis → MDC 18 (Infectious and Parasitic Diseases), OR may group under 579-581 (Other ENT OR Procedures) depending on grouper version POA: B46.1 = Y (present on admission driving the surgery)

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Example 6 — Partial Rhinectomy After Mohs: ENT Performs Deep Resection

A patient undergoes Mohs micrographic surgery by a Mohs surgeon for nasal tip SCC with clear cutaneous margins. However, residual tumor is identified at the deep margin involving the lower lateral cartilage. ENT is asked to perform cartilage resection to achieve a negative deep margin. ENT takes the patient to the OR and resects the involved lower lateral cartilage dome with a 3 mm margin; clear margins confirmed by frozen section. Wound is closed with primary layered repair.

Mohs Surgeon CPT: 17313 (Mohs, head/neck/hands/feet — first stage, each additional stage) + applicable repair codes ENT CPT: 30150 — Rhinectomy, partial (cartilage/deep margin resection) Note: ENT bills 30150 because full-thickness cartilage resection was performed; the Mohs surgeon bills their separate Mohs code sequence; these are two separate physicians, two separate claims under separate NPIs; co-surgery rules do not apply as they were performing distinct, sequential procedures ICD-10-CM:C44.321 — SCC skin of nose for both providers

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Example 7 — Partial Rhinectomy with Concurrent Selective Neck Dissection

A 65-year-old woman with T2N1 squamous cell carcinoma of the nasal cavity (C30.0) with ipsilateral level IB lymphadenopathy undergoes partial rhinectomy and simultaneous right selective (levels I-III) neck dissection.

CPT: 30150 — Rhinectomy, partial CPT: 38724-51 — Selective neck dissection with modifier -51 (multiple procedures) CPT: 15731 — Paramedian forehead flap (if performed) ICD-10-CM (Principal): C30.0— Malignant neoplasm of nasal cavity ICD-10-CM (Secondary): C77.0 — Secondary malignant neoplasm, lymph nodes of head, face, neck MS-DRG: 146 (ENT malignancy with MCC — C77.0 is MCC) or 011-013 if tracheostomy also performed Note: Neck dissection is never bundled into 30150; it is always separately reportable as a distinct anatomical operation

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Documentation Requirements for Optimal Coding and Audit Defense

Robust operative documentation is essential for 30150 — both to support the code choice and to capture the full value of simultaneous reconstructive services. The operative report should include:

• Diagnosis and indication — documented preoperative malignancy or other indication; reference to prior biopsy/Mohs result or pathologic confirmation
• Nasal subunit involvement — identify which of the nine nasal subunits were resected; document which subunits were preserved
• Tissue layers resected — explicitly state whether cartilage or bone was removed (“the lower lateral cartilage was included in the resection at the alar margin,” “the upper lateral cartilage was transected 5 mm from the dorsum”)
• Margin assessment — document frozen section submissions, number of blocks, and reported results; document that clear margins were confirmed before closure
• Reconstruction performed — describe each reconstructive step distinctly: flap type, dimensions, pedicle basis, donor site, closure method; these details justify separate reconstruction CPT billing
• Pedicle flap stage designation — for forehead flaps, note “Stage 1 — pedicle left intact; Stage 2 pedicle division planned in 3-4 weeks” to set up modifier -58 billing
• Co-surgeon/assistant documentation — identify the assistant surgeon’s role, especially in complex cases with simultaneous neck dissection or free flap reconstruction
• Operative time — relevant for unusual circumstance modifier (-22) justification and anesthesia billing
• Complications — document any intraoperative events clearly to support return visit coding if needed

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Differential Coding — When to Use Adjacent Codes Instead of 30150

Clinical Scenario	Correct Code	Rationale
Skin-only excision of nasal malignancy, cartilage intact	11640-11646 (malignant lesion excision by size)	No framework involvement → not a rhinectomy
Mohs surgery, nose, with cutaneous margins only	17311-17315 + repair	Skin-layer Mohs without cartilage invasion
Total external nose removed	30160	Entire nose amputated → total rhinectomy
Intranasal tumor excision, no external nasal skin/cartilage removed	30117/30118	Internal approach only; external nose not violated
Nasal polyp excision	30110/30115	Benign polyp; not a rhinectomy
Turbinate resection only	30130/30140	Entirely different nasal structure
Nasal bone fracture repair	21310-21325	Trauma reduction; not excision
Rhinoplasty for cosmetic or functional septorhinoplasty	30400-30420	Reconstruction/cosmetic; no cancer resection
Partial rhinectomy + neck dissection	30150 + 38724-51	Both reported; distinct procedures
Partial rhinectomy + forehead flap	30150 + 15731	Both reported; reconstruction separately coded
Reconstruction only (staged, second session, different day)	15731-58, 14060, 15240	Modifier -58 for staged work during global

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Quick Reference Summary

Field	Detail
Code	30150
Type	CPT Procedure Code
Full Descriptor	Rhinectomy; partial
Setting	Operating Room only (Hospital Inpatient, HOPD, ASC)
Anesthesia	General endotracheal anesthesia required
Global Period	90 days
wRVU	~15.11 (may be carrier-priced; verify locally)
HCC	No (procedure code); paired diagnoses (C44.x, C30.0) ARE HCC
Assistant Payable	Yes — Medicare indicator 1 (with medical necessity documentation)
Bilateral	Not applicable (single midline structure)
vs. 30160	30150 = some nasal structure preserved; 30160 = entire external nose removed
Reconstruction	Separately reportable — 14060, 14061, 15240, 15731, 20912, etc.
Staged Reconstruction	Modifier -58 for planned stages within global period
Return to OR complication	Modifier -78 for unplanned OR return
Unrelated E&M during global	Modifier -24
Key NCCI	30150 and 30160 mutually exclusive; reconstruction codes NOT bundled
Key DRGs	146/147/148 (ENT malignancy); 011-013 (tracheostomy if concurrent); 579-581 (other ENT OR, non-malignant)
Common Errors	Billing 30150 for skin-only excision; not billing reconstruction separately; using -78 instead of -58 for staged flap; forgetting modifier -51 for concurrent neck dissection