Pulmonology Coding Alert

Question: After one physician performed a laryngoscopy and bronchoscopy, the physician in our practice dictated for a tracheostomy. The operative report states that after resecting a portion of the thyroid and ligating the ends of the wound, the physician freed up one inch of thyroid tissue in the midline with partial resection of the thyroid gland. After about a half-hour of dissection, the physician found the thyroid cartilage, sectioned a bit of the tracheal ring about 2 mm off the midline on each side and inserted the tracheal tube. Should I report 31600 or 31610?
       
Michigan Subscriber

Answer: You should always code only for those procedures the physician specified in the documentation.

You describe a tracheostomy, which does not include a fenestration procedure, so you should report 31600 (Tracheostomy, planned [separate procedure]). If the physician documented a bronchoscopy, you can also report 31622 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing [separate procedure]).

If the physician performed a laryngoscopy as a separate procedure from the bronchoscopy, you would use 31505 (Laryngoscopy, indirect; diagnostic [separate procedure]) with modifier -59 (Distinct procedural service), which notifies your carrier that the physician completed the laryngoscopy separately from the bronchoscopy. But if the physician did not document the laryngoscopy or bronchoscopy, you should not submit a code for either procedure.