Otolaryngology Coding Alert

Consider volume, payer when determining 31365 or 31360/38724-59 strategy

When deciding whether to bill a laryngectomy with MRND as 31365 or as 31360/38724-59, you may adopt one of three expert-suggested policies.

1. Always Separately Report the MRND

If you decide to always code an MRND (38724) with laryngectomy, you may have to battle insurers for 38724 payment. "Be prepared for insurers to deny the MRND," says Andrew Borden, CCS-P, CPC, CMA, reimbursement manager at the Medical College of Wisconsin in Milwaukee. "You should create a form letter explaining that it's inappropriate to bundle the MRND with the laryngectomy."

Your letter should also note that 31365 doesn't describe a laryngectomy with MRND. "Code 31365 is for a radical neck dissection, not a modified radical neck dissection," Borden says.

2. Always Combine the Procedures

You may, however, deal with numerous insurers that combine 31360 and 38724 into 31365. Instead of tackling insurers' policies, you may decide to follow their lead and bill a laryngectomy with MRND as 31365. "We always combine the operations," Borden says.

Consideration: If you bill many laryngectomies with MRNDs, the $56-plus loss from insurers may make a difference. For practices that infrequently code these procedures, the reimbursement cut may not make denial work worthwhile.

3. Bill Based on Payer

To maximize reimbursement, you could research major insurers' laryngectomy-with-MRND policies and bill each payer accordingly. If you choose this approach, keep track of your EOBs and post a list of each insurers' rules.

Problem: Billing payers different ways may cause compliance problems. "You should instead code the laryngectomy with MRND the way you feel is appropriate, such as with modifier -59," says Barbara Cobuzzi, MBA, CPC, CPC-H, president of Cash Flow Solutions, a physician billing firm in Brick, N.J. "That way you can always explain the method you chose."