Otolaryngology Coding Alert

Find out why experts back billing both 31365 & 31360/38724-59 Weigh the reasons some real-world ENT coders bill a laryngectomy and a modified radical neck dissection (MRND) as a single code (31365) while others report the procedures as two codes (31360 and 38724-59). No Code Describes Larynx Removal and MRND Unlike the total laryngectomy codes (31360, Laryngectomy; total, without radical neck dissection; 31365, Laryngectomy; total, with radical neck dissection), CPT lacks a code that combines a laryngectomy with an MRND.

"The total laryngectomy codes describe either a laryngectomy without radical neck dissection (31360) or with radical neck dissection (31365)," says Andrew Borden, CCS-P, CPC, CMA, reimbursement manager in the Department of Otolaryngology and Communication Sciences at Medical College of Wisconsin in Milwaukee.

Case study: When an otolaryngologist performs a total laryngectomy without neck dissection (31360) and also does a cervical lymphadenectomy (MRND) (38724, Cervical lymphadenectomy [modified radical neck dissection]), coders aren't sure whether they should bill both codes, says Robin M. McCabe, CPC, surgery specialist coder at Southern Illinois University School of Medicine in Springfield. "Should I use modifier -59 (Distinct procedural service) on 38724?" she asks.

While 31360 and 38724-59 is a possibility, another coding option also exists -rolling the codes into 31365.

Here are the pros and cons of each. Option 1: Separately Report Each Procedure Because no code describes a laryngectomy with MRND, you could separately bill the operations. "You could split out the procedures," Borden says.

Method 1 Unilateral MRND. You would bill:
   31360 - Total laryngectomy without RND
   38724-59 - Cervical lymphadenectomy (MRND). Method 1 Bilateral MRND. If the otolaryngologist performs a laryngectomy and bilateral cervical lymphadenectomy, you could assign:   31360 - Total laryngectomy without RND
   38724-50-59 - Bilateral cervical lymphadenectomy (MRND).

Editor's note: When reporting bilateral claims, you may have to use two lines or double your fee depending on the insurer. Coding MRND Is Technically Correct Because no code describes a laryngectomy with radical neck dissection, breaking out the codes is technically correct. "A MRND has a significantly different work value than an RND," says Randa Blackwell, coding specialist at The 33rd Street Surgery Center in Baltimore.

In addition, the MRND is a completely different procedure from the laryngectomy. "The MRND is a significant, separate procedure that the total laryngectomy codes don't include," Blackwell says. 31360/38724 Payment Hinges on Insurer But insurers may include the MRND code 38724 in the laryngectomy code 31360. The National Correct Coding Initiative (NCCI), version 11.0, bundles 38724 into 31360, so payers' computer systems may incorporate the edit.

Out: For Medicare, you can use modifier -59 to break the bundle. "The NCCI edits allow a modifier to override the 38724 and 31360 bundle," Borden says.

Private payers may or may not require modifier -59 on [...]