Otolaryngology Coding Alert

Question: How can we report a modified radical neck dissection (MRND) with laryngectomy? Should we use 31365, or is there a more appropriate code?


Oregon Subscriber

Answer: As written, CPT's total laryngectomy codes describe either a laryngectomy without radical neck dissection (31360, Laryngectomy; total, without radical neck dissection) or with radical neck dissection (31365, - total, with radical neck dissection). CPT lacks a code that specifically combines a laryngectomy with cervical lymphadenectomy, or MRND.

You have two potential options when coding total laryngectomy with MRND:

1. Report 31360 and claim the MRND separately using 38724 (Cervical lymphadenectomy [modified radical neck dissection]).

2. Combine both procedures into 31365.

The first approach is probably the best.

Keep in mind, however, that if you report the procedures this way, you should append modifier 59 (Distinct procedural service) to 38724. Although the MRND is a significant, separate procedure from the laryngectomy, the National Correct Coding Initiative bundles 38724 into 31360, and therefore you-ll need modifier 59 to override the edit.

Watch for: Some payers will refuse separate payment for 38724 with 31360 and will instead insist that both procedures are included in 31365. From a clinical standpoint, this practice is suspect--an MRND as described by 38724 is significantly different from the radical neck dissection included in 31365--but there are payers that simply won't budge on the issue.

Payment doesn't differ considerably: Using Medicare pay schedule rates, reporting 31365 instead of 31360 and 38724-59 will reduce your payment by less than $75.

Consider bilateral dissections: In some cases, the otolaryngologist will perform cervical lymphadenectomy (MRND) bilaterally with the laryngectomy. This will affect your coding: If you are claiming the lymphaden-ectomy and laryngectomy separately, you would report:

- 31360 for laryngectomy without radical neck dissection

- 38724-59-50 (Bilateral procedure) for the bilateral cervical lymphadenectomy (MRND).

Note that some payers may require you to separate the bilateral MRND onto two lines, as follows:

- 38724-59

- 38724-59-50.

If you are -combining- the MRND and laryngectomy into a single code, but the surgeon performs MRND bilaterally, you should claim:

- 31365-RT (Right side) for the total laryngectomy with radical neck dissection

- 38724-59-LT (Left side) for the MRND on the opposite (-contralateral-) side.