Otolaryngology Coding Alert

Question: The January Otolaryngology Coding Alert states that 31601 has more relative value units (RVUs) than 31600. My Medicare information from 2002 lists the fee for 31600 as substantially higher than 31601's fee. This would suggest that the RVU is less. Which is the correct information?

Florida Subscriber

Answer: A review of the past three Medicare Physician Fee Schedules, 2001-2003, shows that 31601 (Tracheostomy, planned [separate procedure]; under two years) (7.04 RVUs in 2002 and 3.99 in 2003) actually has fewer RVUs than 31600 (Tracheostomy, planned [separate procedure]) (10.67 RVUs in 2002 and 10.57 RVUs in 2003). However, the 2001 fee schedule assigned 31601 more RVUs (7.78) than 31600 (6.26). So, from 2001 to 2002, CMS reversed which code received more RVUs. The American Association of Otolaryngologists Head and Neck Surgeons is working on correcting this anomaly, which resulted from the five-year review for 31600 that did not apply to 31601.

As reported in the June 2001 Otolaryngology Coding Alert, "Children under age 2 may require planned tracheostomies for a variety of conditions, including sub-glottal stenosis, a benign laryngeal tumor or paralyzed vocal cords. Such cases are more difficult, and should be reported using 31601, which should reimburse at a higher rate than a planned tracheostomy on an adult." This logic is still true. Relative values are supposed to reflect the inherent work included in a code, and a pediatric code obviously entails more work than its adult counterpart.

Therefore, the January 2003 Otolaryngology Coding Alert article should read: "Despite the fact that planned tracheostomies on small children may require significantly more work than a trach for an adult, 31601 now has fewer relative value units than 31600."

Regardless of the RVUs, modifier -63 (Procedure performed on infants) applies to 31601 if the otolaryngologist performs the procedure on an infant. Code 31601 should eventually contain the extra physician work for performing the procedure on small children, but that will still not apply to extreme cases, such as infants. When an otolaryngologist performs the procedure on a neonate or infant up to a present body weight of 4 kilograms, you may use modifier -63 to indicate the increased complexity and physician work associated with these patients. CPTdoes not designate 31601 as modifier -63 exempt as other codes are, such as 31520 (Laryngoscopy, direct, with or without tracheoscopy; diagnostic, newborn).

Answers to You Be the Coder and Reader Questions contributed by Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J; and Charles F. Koopmann, MD, MHSA, professor and associate chair of the department of otolaryngology, physician billing director, and a member of the faculty group practice at the University of Michigan in Ann Arbor.