Otolaryngology Coding Alert

Question: An otolaryngologist reported 12042 and 38542. Is that an appropriate combination?


Florida Subscriber

Answer: Even though the National Correct Coding Initiative (NCCI) 10.3 doesn't include 12042 (Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less) in 38542 (Dissection, deep jugular node[s]), you shouldn't report these codes together unless the otolaryngologist performs them at separate locations.
 
Why: Code 38542 includes a closure. Because neck closure is integral to lymph node dissection, 38542's description and relative value units include closing the neck. Therefore, you shouldn't bill the layer closure (12042) in addition to the surgical procedure (38542).

When reporting a repair with a surgery, follow this general coding guideline:

Don't bill for closures of any major surgical incision.

Translation: If the otolaryngologist performs the repair (12042) to close the procedure (38542), the closure is inclusive in the operation - in this case the neck dissection.

- Reader Questions and You Be the Coder reviewed by Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Brick, N.J.; and Charles F. Koopmann Jr., MD, MHSA, professor and associate chair at the University of Michigan's Department of Otolaryngology in Ann Arbor.