Pulmonology Coding Alert

Codes for graft harvesting in larynx simplify reporting 

If you've struggled to find the right codes to report bronchial stents and laryngoscopies, starting Jan. 1 you can use new and improved codes that include location and graft reconstruction specifics.  

Laryngoscopies Under 'Reconstruction' in 2005

Old way: Prior to the upcoming CPT additions, laryngoscopy codes (31505-31579) did not identify the specific procedural details that distinguish among indirect, direct or flexible laryngoscopies.

As a result, you often had to check the physician's documentation carefully - not just the description of the procedure at the top of the operative report - to ensure that you billed for the correct kind of procedure.

New way: CPT 2005 introduces two new codes (31545, Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion[s] of vocal cord; reconstruction with local tissue flap[s]; and 31546, Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion[s] of vocal cord; reconstruction with local tissue flap[s] reconstruction with graft[s] [includes obtaining autograft]) to cover direct laryngoscopy procedures using an operating microscope or telescope, "with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with local tissue flap(s)."

These new codes came about because physicians thought the old laryngoscopy codes didn't accurately describe the work they were doing, says Steve Peters, a pulmonary and critical care medicine consultant at the Mayo Clinic in Rochester, Minn.

The new codes cover the physician's work to obtain the autogenous graft within the basic surgical procedure, says Roger Hettinger, CPC, CMC, CCS-P, coding specialist with Sioux Valley Clinic in Sioux Falls, S.D.

CPT Simplifies Laryngoscopy Coding

Before the advent of these new codes, coders were forced to report a separate CPT code for the physician's work to harvest the graft, Hettinger says.

Pitfall: When you have to report a separate code for the physician's efforts to harvest the graft, you can easily overlook the additional graft code and not report it at all. This results in missed revenue for the physician's practice, Hettinger says. 

Solution: With the addition of the new code, reporting one CPT code for the total procedure should help your reimbursement, Hettinger says, because payers won't bundle the graft harvesting into the surgical procedure since it's all reported with one CPT code.

Bonus: CPT 2005 also includes one new add-on code (31620) for endobronchial ultrasound (EBUS) during a bronchoscopic diagnostic or therapeutic intervention. 

New Codes Cover ALL of Your Stent Bases

Pulmonology practices also gain three new bronchial stenting codes. Two codes cover stent placement specific to the bronchus and each additional major bronchus the physician stented: 31636, Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with placement of bronchial stent(s) (includes tracheal/bronchial dilation as required), initial bronchus; and +31637, ... each additional major bronchus stented (list separately in addition to code for primary procedure). CPT designates 31637 as an add-on code.

A third code (31638, Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with revision of tracheal or bronchial stent inserted at previous session [includes tracheal/bronchial dilation as required]) covers revision of tracheal or bronchial stent revisions. These codes include tracheal/bronchial dilation as needed.

Also, CPT 2005 revises bronchoscopy code 31631 to cover bronchoscopy with stent placement specific to the trachea, including tracheal/bronchial dilation.

Previously, the codes assumed that physicians would use only a single stent for the tracheal/bronchial area, Peters says. But many patients require complicated stent procedures.

For example, some patients require a tracheal stent, followed by a bronchoscopy and a debulking, and then the surgeon decides a main stem bronchial stent is necessary. "There was no provision for more than one thing being done," Peters says.