Otolaryngology Coding Alert

Question: Medicaid bundles 31525 and 31622 when we bill them together. What can we do to appeal these denials?


Utah Subscriber

Answer: The National Correct Coding Initiative (NCCI) implements an edit on this laryngoscopy and bronchoscopy pair. Therefore, Medicaid may also bundle 31525 (Laryngoscopy, direct, with or without tracheoscopy; diagnostic, except newborn) into 31622 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing [separate procedure]).

Good news: The edits allow a modifier, when appropriate, to override the bundle. For instance, if the otolaryngologist performs the scopes at different, same-day sessions, you could use modifier 59 (Distinct procedural service) to unbundle the direct laryngoscopy (DL).

Remember: The 31525-31622 bundle is an NCCI edit from CMS. Some private payers will pay the laryngoscopy if the dictation includes the following points:

1. The surgeon separates the DL and bronchoscopy procedures in separate paragraphs.

2. The surgeon states that he used different instruments--a laryngoscope and then a bronchoscope.

3. The surgeon states what conditions he used each procedure and instrument to evaluate.

The above documentation guidelines separate the procedures in great detail and occasionally result in payment for each. It may also protect the physician against fraud and abuse charges.