Otolaryngology Coding Alert

Question: Our provider performed a routine planned tracheostomy that includes the following documentation within the operative report: “I vertically divided the superficial layer of deep cervical fascia using monopolar cautery. I then continued dissection until the thyroid isthmus was identified. The isthmus was partially divided using bipolar electrocautery”

Can I bill for 60200 in addition to the tracheostomy?

Michigan Subscriber

Answer: The key to answering this question requires a firm understanding of what services to include within the planned tracheostomy, which you will report with 31600 (Tracheostomy, planned (separate procedure)). Despite the fact that this question routinely poses headaches for otolaryngology coders, you won’t find much authoritative instruction to guide your CPT^® code reporting.

You also should not assume that 31600 and 60200 (Excision of cyst or adenoma of thyroid, or transection of isthmus) are eligible for reporting together since no National Correct Coding Initiative (NCCI) bundling edits exist. That’s because excision of the thyroid isthmus (either partial or complete) is often necessary in order to properly expose the trachea.

However, you may consider appending modifier 22 (Increased procedural services) to 31600 if the surgeon indicates that the work to divide the isthmus exceeded the work that’s included in a routine tracheostomy. As per Appendix A of the CPT^® book, modifier 22 is applicable in instances where “the work required to provide a service is substantially greater than typically required. This might be indicated through increased intensity, increased time, technical difficulty of the procedure, severity of the patient’s condition, or physical and mental effort required.