Otolaryngology Coding Alert

Question: When an otolaryngologist performs a tracheostomy with a Bjork flap or inferior tracheal flap, is CPT 31600 the correct code?


Louisiana Subscriber

Answer: No, you should not report a tracheostomy that involves a flap with 31600 (Tracheostomy, planned [separate procedure]). Code 31600 does not encompass the flaps. You should instead use 31610 (Tracheostomy, fenestration procedure with skin flaps).

Because 31610 includes the skin flaps, it pays at a much higher rate than 31600. Medicare reimburses 31610 at a national rate of $674.95 (8.75 work value and 17.81 relative value units [RVUs] x 37.8975 conversion factor). Code 31600 nationally pays $422.94 (7.17 work value and 11.16 RVUs).

One of the reasons for the payment difference is that 31600 has zero global days, whereas 31610 has a 90-day global period.

 - Answers to You Be the Coder and Reader Questions provided by Ellen Allison, RHIA, CPC, a coding instructor and consultant in Buffalo, N.Y.; Pamela J. Biffle, CPC, CCS-P, ACS-DE, approved PMCC instructor, product development director of Custom Coding Books in Bellevue, Wash.; Tara R. Ritter, CPC, billing and reimbursement specialist at Robert A. Gadlage, MD, PC, in Duluth, Ga.; and Hayes H. Wanamaker, MD, an otolaryngologist at Central New York Ear, Nose & Throat Consultants in Syracuse.