Otolaryngology Coding Alert

Answer: Ludwig angina is a common infection of the submental area. A form of cellulitis, Ludwig angina involves inflammation of the tissues of the neck, the jaw and below the tongue. It may occur following an abscessed tooth or other oral trauma. Affected tissues may swell rapidly and cause an airway obstruction, which may require intubation or a tracheostomy. Antibiotics usually stop the infection; however, surgery to drain the neck may be required.
 
The surgery may be external (through skin) or internal (from inside the body), a distinction that is significant for coding. If the incision to drain the abscess is performed externally, use 21501 (incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax). If the procedure is performed internally, use 41000 (intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; lingual), 41005 (... sublingual, superficial) or 41006 (... sublingual, deep, supramylohyoid).
 
Any E/M service that prompted the decision to perform surgery is paid separately and should be appended with modifier -57 (decision for surgery).