Otolaryngology Coding Alert

Question: Many of our biopsy procedures have a 10-day global period. What is the purpose of this global period? Is it necessary to delay definitive surgical procedures until the 11th day following a biopsy to treat a person with cancer? Specific examples of this would include biopsies of the oral cavity, oropharynx, tongue and nasopharynx.

Joseph Valentino, MD
Lexington, Ky.
Answer: You are correct that the biopsy procedures mentioned have a 10-day global period. These include:

  40808 -- biopsy, vestibule of mouth
  41100 -- ... of tongue; anterior two-thirds
  41105 -- ... posterior one-third
  41108 -- ... floor of mouth
  42800 -- ... oropharynx
  42804 -- ... nasopharynx, visible lesion, simple
  42806 -- ... nasopharynx, survey for unknown primary lesion.
This does not mean that procedures to treat a cancer patient should be delayed, or that if the procedures are carried out during the global period the otolaryngologist will not get paid, says Susan Callaway, CPC, CCS-P, an independent coding and reimbursement specialist and educator in North Augusta, S.C.

This is a classic example of when to use modifier -58 (staged or related procedure or service by the same physician during the postoperative period). For instance, the otolaryngologist performs a biopsy of tongue (41100). The pathology report, which returns a few days later, indicates the presence of a malignant tumor. The otolaryngologist then decides to excise the tumor (41120, glossectomy; less than one-half tongue).

When the glossectomy is billed, modifier -58 is appended to 41120 to indicate a staged procedure that should not be included in the biopsys 10-day global period.

In this case, the glossectomy was not preplanned (although it is still considered staged) because had the biopsy returned negative, it would not have been performed. Modifier -58 should be used whether or not the procedure is preplanned.

Note: A biopsy performed by laryngoscopy (i.e., 31510, 31535, 31536 or 31576) has zero global days.