Otolaryngology Coding Alert

Question: How should I code supracricoid laryngectomy? Would you give an example or guideline explaining how to code all the portions of this surgery?

New York Subscriber Answer: You should report the operation as 31367 (Laryngectomy; subtotal supraglottic, without radical neck dissection). The controversial, recently developed supracricoid technique is similar to a supraglottic laryngectomy in which the otolaryngologist contains the resection to the laryngeal structures above the vocal cord/arytenoid areas only. The laryngectomy code includes all related laryngeal tissue/cartilage procedures and a tracheotomy.

If your otolaryngologist also removes lymph nodes, you should separately report this surgery. For instance, if the surgeon performs a cervical lymphadenectomy with a modified radical neck dissection, you should submit 38724-51 in addition to 31367. Append modifier -51 (Multiple procedures) to the lymphadenectomy code to indicate that the surgeon performs a multiple procedure.

Some payers, such as Medicare, may not require the modifier on the lesser-valued procedure. Insurers will probably pay the lymphadenectomy at 50 percent, based on multiple-surgery payment rules. This cut will result in $2,047.72 (2004 national fee) in payment, which includes $1,535.79 for the laryngectomy and $511.93 for the lymphadenectomy.