Otolaryngology Coding Alert

Question: I was always told that 31600 is bundled with a hemiglos­sectomy (41130), but billable with a partial glossectomy (41120) or less, but I can’t find anything to support this. Can you shed any insight on this?

AAPC Forum Participant

Answer: Your information is only partly correct. A planned tracheostomy, coded to 31600 (Tracheostomy, planned (separate procedure)) is payable separately with 41120 (Glossectomy; less than one-half tongue), as you say, but it is also not bundled with 41130 (Glossectomy; hemiglossectomy).

However, the procedure is bundled with complete glossectomies, coded to 41140 (Glossectomy; complete or total, with or without tracheostomy …) and 41145 (Glossectomy; complete or total, with or without tracheostomy …).

One look at the code descriptors for the glossectomy and complete glossectomy procedures will tell you why. These procedures include the insertion of a feeding tube, whereas the surgeries associated with 41120 and 41130 only remove part of the tongue, and tracheostomies for these encounters would be taken on a case-by-case basis. In other words, “codes 41140, 41145, 41150, 41153 include tracheostomy (code 31600) [as] insertion of a feeding tube at the time of these surgeries would be considered an inclusive service,” according to the August 2010 CPT^® Assistant (Volume 20: Issue 8).

This is confirmed by the National Correct Coding Institute (NCCI) procedure-to-procedure (PTP) edits associated with the codes. When 31600 is listed as the column 2, or component, code to 41140, 41145, the codes have a modifier indicator of 0, meaning Medicare will not allow you to override the edit. Code 31600 is not a Column 2 code for 41120 and 41130, and composite glossesctomies, coded to 41150 (Glossectomy; composite procedure with resection floor of mouth and mandibular resection …) and 41153 (Glossectomy; composite procedure with resection floor of mouth …), however.