Wiki 31528 vs 31529 documentation guidelines.

[Jpad]

Hello,

What is the difference between 31528 & 31529? When does a dilation make it initial or subsequent?

For instance, is it initial if it's the first time there was a dilation? Is it subsequent dilation for the rest of dilations done?

 

[JenniferB7]

In general, the first dilation is the "initial" dilation (31528) and any "subsequent" dilations by that provider/provider group would be (31529). If the patient's condition resolves and he/she comes back 10 years later with a new problem or recurrence of the old problem that requires dilation again, then you could (in theory) bill "initial" dilation (31528) again. You have to look at the overall clinical picture. Having said that, some payers follow different rules, like Medicare that covers a new patient visit once per the lifetime of the patient with that provider instead of adopting CPT rules that states a patient is considered "new" if not seen in the last 3 years. Definitely check your payer guidelines.

Hope that helps!

 

[hthr.santos]

Would the following be coded with both 31528 AND 31529?

After completion of diagnostic laryngoscopy and bronchoscopy, the suspension arm was affixed
to the laryngoscope and dilation of the trachea was performed. The 5 mm balloon was inserted
atraumatically and inflated to 16 atmospheres for 30 seconds under direct visualization. This
was repeated with a 7 and 9 mm two additional times. Excellent dilation of the stenotic area
was noted.

 

[b.cobuzzi]

Only one dilation is coded per operative session. If you had checked CCI, you would see that subsequent 31529 is bundled into initial 31528.