Part B Insider (Multispecialty) Coding Alert

Published on Thu May 19, 2005 PDF

 When you can - and can't - legitimately unbundle

CPT 2005 introduced two new codes for laryngoscopy with tumor removal and reconstruction: 31545-31546. Coders rejoiced because until recently there was no code that included both lesion removal and reconstruction with local tissue flaps or grafts.

But the newest update to the Correct Coding Initiative, which takes effect in July, makes it much more difficult to bill 31545-31546. Next month, those new codes will become part of excision codes 31300-31420. And you can't use a modifier to override those edits.

These edits make sense, says Asia Evans, coding specialist at Head and Neck Surgery Associates in Indianapolis, IN. Both 31545 and 31546 refer to lesion removal, while 31300-31420 refer to removing the whole larynx. "Clearly if you bill for taking the larynx out, you're not going to bill for taking a lesion off the vocal cord," explains Evans.

Nor can you use a modifier to override new edits that make 31545-31546 mutually exclusive with lesion removal codes 31512 and 31578, and 31546 mutually exclusive with lesion removal code 31545.

Good news: You can use a modifier to override edits bundling laryngoscopy codes 31525-31526, 31535-31536 and 31576 with 31545-31546. But you won't be able to use a modifier to override edits that make laryngoscopy codes 31505-31510, otolaryngologic examination code 92502 and aural rehab code 92510 components of 31545-31546.

Also, laryngoscopy code 31575 will become a component of new bronchial stent placement code 31636 and new upper gastrointestinal endoscopy code 43257. These edits also aren't susceptible to a modifier override.

A dozen codes become components of new bronchoscopy codes 31636 and 31638, including endoscopy code 31321, laryngoscopy codes 31525-31526, 31535-31541 and 31575, catheterization codes 31717-31725 and nasopharyngoscopy CPT 92511 . You can use modifiers to override some of those edits, but not others.

Starting in July, transvenous cardiac electrode insertion/replacement codes 33210-33211 become components of pacemaker codes 33200-33201, 33207-33208, 33214-33220, 33224, 33226, 33234-33237, 33244 and 33249. You can use a modifier to override all but one of those edits.

Catheter introduction code 36010 will become a component of selective catheter placement codes 36011-36015. First-order catheter code 36011 also becomes a component of second-order code 36012, and main pulmonary artery code 36013 becomes a component of pulmonary artery code 36014. Also, 36013 and 36014 will be components of segmental or subsegmental pulmonary artery code 36015.

CPT codes 36010-36012 also become components of endovenous ablation therapy codes 36475 and 36478. A modifier will be able to override all of the edits bundling 36010-36015.