Otolaryngology Coding Alert

You Be the Coder:

CCI Changes Billing for Bilateral,Modified RND

Published on Sat Feb 01, 2003

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Should I bill Medicare for a bilateral radical neck dissection (RND) when I also perform a partial glossectomy? Florida Subscriber

CCI Changes Billing for Bilateral,Modified RND Answer: Thanks to the most recent version (9.0) of the national Correct Coding Initiative (CCI), you may now bill Medicare for both the partial glossectomy (41135, Glossectomy; partial, with unilateral radical neck dissection) and the second radical neck dissection (38720, Cervical lymphadenectomy [complete]). The glossectomy includes the first (unilateral) RND. To indicate that the second RND occurs at a different site from the unilateral RND, append modifier -59 (Distinct procedural service) to 38720. In addition, when the otolaryngologist performs a modified RND, you should bill 38724-59 (Cervical lymphadenectomy [modified radical neck dissection]) instead of 38720. CCI changed the modifier indicator for 41135, 41145 ( complete or total, with or without tracheostomy, with unilateral radical neck dissection) and 42426 (Excision of parotid tumor or parotid gland; total, with unilateral radical neck dissection) from "0" to "1," which means that under certain circumstance you can use modifier -59 to bypass the edits. Codes 41135, 41140 ( complete or total, with or without tracheostomy, without radical neck dissection) and 41150 ( composite procedure with resection floor of mouth and mandibular resection, without radical neck dissection) also now contain a "1" for the modified RND code (38724). The changes, effective Jan. 1, mean you can bill for the second RND (38720) when performed with a

partial glossectomy (41135)
complete glossectomy (41145)
total parotid excision (42426). The procedures include unilateral RND only. Append modifier -59 to the second RND. In addition, you can report a modified RND (38724) with a laryngectomy (31360, Laryngectomy; total, without radical neck dissection) partial glossectomy (41135) complete glossectomy (41140) composite procedure (41150).

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