Otolaryngology Coding Alert

Question: One of our physicians performed a tracheostomy on a patient with laryngeal carcinoma. The patient was admitted after the procedure and has remained inpatient for two months. Our physician sees the patient daily sometimes twice a day due to his debilitated condition, tube feedings and laryngeal carcinoma. The doctor feels he should be able to charge for hospital visits. I feel that this is probably within the global period from the tracheostomy. Who is correct?

Connecticut Subscriber

Answer: The answer depends on the specific tracheostomy procedure performed.

CPT lists two procedures (31610, tracheostomy, fenestration procedure with skin flaps; and 31611, construction of tracheoesophageal fistula and subsequent insertion of an alaryngeal speech prosthesis [e.g., voice button, Blom-Singer prosthesis]) with 90-day global periods. If either of these procedures was performed, all the otolaryngologists hospital visits would be included in the procedures global period.

If, however, a temporary tracheostomy was performed (31600, tracheostomy, planned [separate procedure]), one visit per day beginning the day after surgery may be billed because 31600 has zero global days.

Even if the otolaryngologist sees the patient in the hospital more than once a day, only one inpatient visit (99231-99233) is payable. However, the documentation of the history, examination and medical decision-making for both visits may be calculated together to determine the level of visit to be billed. If the criteria for prolonged services are met, additional time spent with the patient may be additionally reimbursed by using codes 99354-99355.

Note: For additional information on billing prolonged services, see Otolaryngology Coding Alert, March 2001, pages 23-24.