Otolaryngology Coding Alert

Question: A patient presents for a follow up visit two weeks following a total thyroidectomy. The physician performs a flexible laryngoscopy to check the status of the vocal cords and larynx. Can I bill for the flexible laryngoscopy?

Texas Subscriber

Answer: The global period for 60240 (Thyroidectomy, total or complete) is 90 days. In order to determine whether the follow up laryngoscopy is separately billable, you’ll want to have a look at the Global Surgery Booklet. On page 6, the Center for Medicare and Medicaid Services (CMS) lays out all the services that are included in the global surgery period. Have a look at one of the points of relevance:

• “Follow-up visits during the post-operative period of the surgery that are related to recovery from the surgery.”

You might think that offers you a clear-cut answer to your question, but things get murkier when you have a look at the services that are not included in the global surgery payment on page 7. Consider this important point:

• “Diagnostic tests and procedures, including diagnostic radiological procedures.”

What was initially a clear-cut decision to include the service as a component of the global period has now become a little more problematic. The underlying question you’ll want to address is whether the laryngoscopy is a diagnostic service. In most instances, a flexible laryngoscopy is performed as a diagnostic service to evaluate the patient’s larynx for an underlying condition or disease. You’ll also see that the term “diagnostic” is even included in the code description for 31575 (Laryngoscopy, flexible; diagnostic).

In this instance, however, the physician performs the flexible laryngoscopy to evaluate the status of the larynx and vocals cords following the thyroidectomy. A follow-up evaluation of these particular sites is typical following a procedure such as a thyroidectomy. Therefore, you should not consider 31575 as a separately payable service.

Coder’s note: Even if the physician performs the flexible laryngoscopy to treat a complication of the thyroidectomy, you would not bill for 31575 within the global period. The Global Surgery Booklet lists the following point as services that are included in the global surgery period:

• “All additional medical or surgical services required of the surgeon during the postoperative period of the surgery because of complications, which do not require additional trips to the operating room.”

However, you’ll want to keep in mind that not all payers follow Medicare’s global payment rules with respect to postoperative complications within the global period. If the payer’s rules are in accordance with the American Medical Association (AMA) guidelines documented in the CPT® manual instead, you may be able to secure reimbursement for postoperative complication services occurring outside of the operating room (OR).