# Tracheostomy - My ENT did a Tracheostomy



## jdibble (Jan 31, 2012)

My ENT did a Tracheostomy with fenestration and skin flaps (31610) but he also wants to bill 60200 for the division of the thyroid isthmus.  Can these be billed separately or is the division of the isthmus part of the 31610?  I have checked CCI edits and they don't hit any edits, but the lay description of 31610 says "the thyroid isthmus is cut if necessary" so I am confused as to whether the 60200 would be billed.  The note is below.

The neck was sterilely prepared and
draped and a shoulder roll was placed.  A 2 cm horizontal incision was created
in the midline anterior neck.  Additionally, the scar of the initial
tracheostomy was resected as an ellipse.  Dissection was carried down through
the strap muscles, and a remnant of the thyroid isthmus was identified and
divided.  The previous tracheostomy tract was identified, and a new incision
was made through tracheal scar tissue from the previous tracheostomy.  This
preexisting tracheostomy tract was then widened and the intubation tube was
removed.  A #8 Shiley cuffed tracheostomy tube was placed and the cuff was
inflated.  The previously created inferiorly-based tracheal flap was then
secured to the skin with suture and tape.  Vicryl sutures were then used to
close the tracheostomy incision and silk sutures were used to secure the
tracheostomy tube to the patient's neck.  CO2 return had been confirmed and
the ventilator was attached. 

Any suggestions are greatly appreciated! 

Thanks,


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## dimmitta (Feb 1, 2012)

In my opinion I would not bill 60200, feeling that it would be included in the trach procedure. In this case it looks like there was a previous tract for this procedure and that it was only a remnant of isthmus left identified makes me think the isthmus was divided in a previous surgery anyway. I just don't see how you could prove it was medically necessary to bill it. Hope this helps!


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## jdibble (Feb 2, 2012)

dimmitta said:


> In my opinion I would not bill 60200, feeling that it would be included in the trach procedure. In this case it looks like there was a previous tract for this procedure and that it was only a remnant of isthmus left identified makes me think the isthmus was divided in a previous surgery anyway. I just don't see how you could prove it was medically necessary to bill it. Hope this helps!



Yes that does help!  I don't think he should be billing the 60200 because when I look up the lay description for the Tracheostomy it states the isthmus is cut if necessary - but I was not sure if that was the same thing as a "transection of the isthmus" as it describes in the code 60200.  He did 3 of these procedures last week and this was the only one where he mentioned that it was a remnant of isthmus (I didn't realize this was the OP note I had chosen - not a good example ). 

Thanks for you help!


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