Otolaryngology Coding Alert

Question: We performed a tracheostomy during a laryngectomy and received a denial for the trach. Can we appeal?

Arkansas Subscriber

Answer: Probably not. Because CPT® defines all planned tracheostomies as “separate procedures,” you must be sure that any trach the ENT provides is not integral to a more extensive procedure. If the trach is incidental (that is, performed as a part of another procedure), you may not report it separately.

Example: If the ENT performs tracheostomy during laryngectomy (31360-31395) or large glossectomy (41140-41155), you may not report the tracheostomy separately. Rather, payment for the trach is included in the fee for the more extensive procedure, of which it is a part.

When you can code: Insurers will allow for a separate, planned tracheostomy when:

• the surgeon performs only the tracheostomy
• the tracheostomy occurs for a different reason than that prompting the primary procedure. In such cases, you should append modifier 59 (Distinct procedural service) to the trach code to distinguish it as a distinct procedure.

Example: An adult patient requires abscess drainage (for instance, 42300, Drainage of abscess; parotid, simple), plus tracheostomy for ventilator management. In this case, the drainage and trach are distinct and occur for different reasons. Report 42300 for the drainage and 31600 (Tracheostomy, planned [separate procedure]), with modifier 59 appended, for the planned trach.