Otolaryngology Coding Alert

Question: How should I code rigid tracheoscopy with tracheal dilation through established trach and placement of a custom-made trach tube (double lumen) performed in the operating room? The otolaryngologist used three sets of tubes (tubes were shortened with the Dremel grinder). Ohio Subscriber Answer: In this situation, your otolaryngologist inserts a rigid tracheoscope, which is the same as a bronchoscope, into the patient's established trach and performs tracheal dilation. In addition, the surgeon leaves a tube or stent in place to support the trachea. For the bronchoscopy with dilation and stent placement, you should report 31631 (Bronchoscopy [rigid or flexible]; with tracheal dilation and placement of tracheal stent). Because this code stipulates that the physician introduce the bronchoscope through the nasal or oral cavity, rather than an existing tracheostomy, you should ask your doctor whether he feels the different entrance involves less work than 31630 includes. If he or she thinks the performed procedure is a reduced service, you should append modifier -52 (Reduced services) to 31630.