Otolaryngology Coding Alert

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Question: A Medicare patient underwent a laryngectomy with primary tracheosophageal puncture. Sometime after surgery, he aspirated the TEP device, which required bronchoscopy with foreign-body removal. Can we bill this procedure with a modifier, or is this considered within the laryngectomys 90-day global period?

Oregon Subscriber


Answer: This procedure would be coded 31635-79 (bronschoscopy [rigid or flexible]; with removal of foreign body - unrelated procedure or service by the same physician during the postoperative period).

In the first operative session, both the appropriate laryngectomy code (31360-31390) and the installation of the transesophogeal puncture (TEP) device (31611, construction of tracheoesophageal fistula and subsequent insertion of an alaryngeal speech prosthesis [e.g., voice button, Blom-Singer prosthesis]) are separately payable, says Randa Blackwell, chief coder for the department of otolaryngology at the University of Maryland in Baltimore.

When implanted, the Blom-Singer device, which gives patients with no larynx the capacity to speak, creates a fistula between the trachea and the esophagus. Sometimes the patient may accidentally aspirate the small device.

The bronchoscopy to remove the aspirated prosthesis is separately payable because it is unrelated to the original laryngectomy and the creation of the tracheoesophageal fistula.