Otolaryngology Coding Alert

Question: A patient had a long-term trach removed, but a scar remains. The otolaryngologist wants to do a scar revision. Should I use 31613 or 31614 for this procedure?

Massachusetts Subscriber

Answer: No, you should instead code a revision of a scar caused by a tracheostomy with 31830 (Revision of tracheostomy scar). This is an excision repair code.

The codes you mention are both incision codes for revision of a hole to correct a tracheostomy's fit, meaning the patient is still breathing through one. Patients who require long-term trachs may require additional procedures due to complications, such as stenosis or narrowing of the trachea (519.02, Mechanical complication of tracheostomy). If the physician revises the opening without flap rotation, you should assign 31613 (Tracheostoma revision; simple, without flap rotation). For more complicated revisions that require flap rotation, report 31614 (- complex, with flap rotation).

If the scar revision is medically necessary -- for instance the scar impairs functionality or causes pain -- when preauthorizing the procedure be prepared to submit evidence showing this fact. For instance, Blue Cross Blue Shield of Massachusetts requires a letter of medical necessity, the patient's history and possibly photographs. Without such evidence, the insurer may consider 31830 cosmetic and uncovered.

-- Answers to You Be the Coder and Reader Questions provided and reviewed by Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.; and Susan Garrison, PCS, FCS, CCS-P, CHC, CPC, CPC-H, CPAR, executive vice president of Magnus Confidential Inc. in Atlanta.