Wiki 31591

[jocoffey]

Hi,
We received a denial on cpt code 31591 with the dx as J38.01(vocal cord paralysis), but it was rejected for an external code needed. Has anyone had this issue? Do we need an Ecode with the dx?

Any help will be appreciated.

 

[JenniferB7]

I have not seen that. Who is the insurance carrier? I can research it and see if I can find out why they are requiring an external cause code.

There is nothing in ICD-10 indicating that an external cause code is required, but there are "use additional code" notes for tobacco use and exposure to smoke. I wonder if the insurance is trying to figure out if there was trauma that caused the vocal cord paralysis. Is there a cause for the VC paralysis listed in the medical records?

If there is no cause documented and the insurance absolutely requires an external cause code, perhaps Y99.9 - Unspecified external cause status would work for an "unknown cause".

Hope that helps!

 

[jocoffey]

I have not seen that. Who is the insurance carrier? I can research it and see if I can find out why they are requiring an external cause code.

There is nothing in ICD-10 indicating that an external cause code is required, but there are "use additional code" notes for tobacco use and exposure to smoke. I wonder if the insurance is trying to figure out if there was trauma that caused the vocal cord paralysis. Is there a cause for the VC paralysis listed in the medical records?

If there is no cause documented and the insurance absolutely requires an external cause code, perhaps Y99.9 - Unspecified external cause status would work for an "unknown cause".

Hope that helps!

The payer is anthem

 

[JenniferB7]

I cannot find a policy by Anthem (or any other insurer for that matter) that states an external cause code is required to bill CPT 31591.

I suspect, however, that since 31591 is a reconstructive procedure (repair of the larynx), that the insurance payer may be classifying this procedure under the general requirements for "reconstructive" versus "cosmetic" surgery. In these cases, the external cause code validates the presence of an injury or trauma and indicates that the reconstructive procedure is to restore function or help return the patient to a pre-trauma state (a covered service). While most insurance carriers focus on liposuction, rhinoplasty, and other more common cosmetic procedures, there are insurance payers that lump all "-plasty" procedures under the cosmetic surgery policy, unfortunately.

In your case, I would contact my provider relations representative and ask for a copy of the policy that states you have to use an external cause code to bill CPT 31591 (or any other official guidance they can provide) since there is no policy currently listed on Anthem's website. If they are not able to produce anything, then ask your representative what you need to do to send the claim back through for reprocessing so that it does not get denied again on the basis of non-existent criteria.

Hope that helps!