Otolaryngology Coding Alert

When reporting post-tracheostomy care, be sure to consider coding for follow-up care, trach changes and potential further procedures to ensure appropriate reimbursement for all services the otolaryngologist performs. After an otolaryngologist performs a tracheostomy, several postsurgery issues emerge, such as reporting follow-up care, trach changes and additional procedures. To find out if you can bill related post-tracheostomy services and procedures, answer three questions. (For advice on selecting the appropriate tracheostomy code [31600-31610], see page 1 of the January 2003 Otolaryngology Coding Alert .) 1. Does the Patient's Carrier Include Follow-Up Care? Although the 2003 National Physician Fee Schedule Relative Value File assigns a zero-day global period to planned tracheostomy codes 31600 (Tracheostomy, planned [separate procedure]) and 31601 ( under two years), many private payers assign a 15-day global to these codes. Consequently, you should separately report any follow-up services, including E/M visits (99231-99233, Subsequent hospital care), for Medicare patients starting the day after surgery (day 1), says Richard A. Chole, MD, PhD, Lindburg Professor and head of the department of otolaryngology at Washington University School of Medicine in St. Louis. "We follow Medicare's global surgical days (and so do most other payers in our area)."

For third-party carriers, you should follow Medicare's policy, says Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J. That way, you will not lose reimbursement for services to which your practice is entitled. If the carrier denies the claim, you should challenge the plan with a letter stating Medicare's policy of a zero-day global. Medicare designates a zero-day global for 31603 (Tracheostomy, emergency procedure; transtracheal) and 31605 ( cricothyroid membrane). Coding experts do not cite a problem with commercial payers imposing a different global period for these codes. They do, however, report conflicting periods for 31610(Tracheostomy, fenestration procedure with skin flaps). Medicare imposes a 90-day global period for 31610. On the other hand, many private payers include a shorter surgical package of 45 postoperative days for this code. Because of this discrepancy, you can start reporting services at day 46 to determine if the payer will allow those services and, if not, write them off when you receive the evaluation of benefits (EOB), Cobuzzi suggests. "Collect data on your payer's different global periods and track them based on the payments you get on your EOBs." 2. How Should You Code a Trach Change? CPT contains only one code for trach tube changes: 31502 Tracheotomy tube change prior to establishment of fistula tract. When an otolaryngologist changes a tracheostomy tube before the fistula tract is fully established, you should report 31502. Although no specific time period [...]