Otolaryngology Coding Alert

Question: How would you code a laryngectomy with bilateral modified neck dissection?

Georgia Subscriber

Answer: Since there is no laryngectomy code that includes a modified radical neck dissection (MRND), you’ve got to apply two individual codes.

• 31360 (Laryngectomy; total, without radical neck dissection) for the laryngectomy
• 38724 (Cervical lymphadenectomy [modified radical neck dissection]) for the MRND

When pairing codes such as these, don’t forget to check the National Correct Coding Initiative (NCCI) edits to make sure they are compatible. In this case, the codes are bundled, but you can override the edit. And remember 38724 is an inherently unilateral code, so modifier 50 (Bilateral procedure) may be necessary.

Here’s what the billing for total laryngectomy with bilateral MRND would look like:

• For payers who only recognize modifier 59:
  • 31360-RT
  • 38724-50-59
• For payers who accept the X{ESPU} modifiers:
  • 31360-RT
  • 38724-XU-RT
  • 38724-XS-LT

Note: You can bill for the second side’s modified neck dissection with modifier 59 (Distinct procedural service) or modifier XS (Separate structure …) because it is located on the contralateral side from that of the laryngectomy.