Wiki Panendoscopy for oral cancer

[jvanbk]

Hello everyone!
I am a biller who is brand new to the field of ENT and am learning as I go -- I was unexpectedly thrown in to the role as the previous coder left with no notice :-o Can you experienced ENT coders please assist me with what seems to be a fairly common set of procedures done by these doctors?

Patients with oral cancer have a triple endoscopy: larynx, bronchial, and esophagus. The larynx is with biopsy. Call all three of these be coded together? The codes I have are 31536, laryngoscopy w/biopsy; 31622, bronchoscopy; and 43191, Esophagoscopy.

Is anyone familiar with the rules pertaining to these three charges billed together on same day? Any assistance is appreciated.

Jennifer

 

[JenniferB7]

This one is very tricky.

Per CPT, the larynx, bronchi, and esophagus are considered separate anatomic sites and are therefore separately reportable. However, Medicare and other payers love to bundle these together. The 2017 NCCI edits bundle 31536 into 31622 citing a "more extensive procedure" and doesn't allow the edit bypass with a modifier. There are no edits for CPT code 43191. For your payers (except Medicare), you will need to append modifier 59 to the bronchoscopy and esophagoscopy codes. For Medicare, make sure you use the XS modifier (instead of 59) to designate a separate structure. Even with the modifiers, you may have to fight for payment for 31536 on appeal given the NCCI edit. I would also encourage to review the operative report and make sure a separate scope was used for each procedure. (laryngoscope for the laryngoscopy; bronchoscope for the bronchoscopy; esophagoscope for the esophagoscopy).

I hope that helps!

Jennifer M. Connell, CPPM, CPMA, CPCO, CPB, CPC, CPC-P, CPC-I, CENTC

 

[jvanbk]

Oh my goodness, this is a tremendous help. Thank you so very much!

Jennifer

This one is very tricky.

Per CPT, the larynx, bronchi, and esophagus are considered separate anatomic sites and are therefore separately reportable. However, Medicare and other payers love to bundle these together. The 2017 NCCI edits bundle 31536 into 31622 citing a "more extensive procedure" and doesn't allow the edit bypass with a modifier. There are no edits for CPT code 43191. For your payers (except Medicare), you will need to append modifier 59 to the bronchoscopy and esophagoscopy codes. For Medicare, make sure you use the XS modifier (instead of 59) to designate a separate structure. Even with the modifiers, you may have to fight for payment for 31536 on appeal given the NCCI edit. I would also encourage to review the operative report and make sure a separate scope was used for each procedure. (laryngoscope for the laryngoscopy; bronchoscope for the bronchoscopy; esophagoscope for the esophagoscopy).

I hope that helps!

Jennifer M. Connell, CPPM, CPMA, CPCO, CPB, CPC, CPC-P, CPC-I, CENTC

 

[nsteinhauser]

In order to code a 43191, per CPT, the examination is from the upper esophagus down to and including the GE (gastroesophageal) junction. You can't code the 43191 unless the esophagoscope is advanced all the way down to the GE junction. Most often in these cases, I see the esophagoscope used to examine the proximal esophagus and post laryngeal area and the surgeon doesn't advance the scope all the way down to the GE junction. Just a thought.

 

[jvanbk]

In order to code a 43191, per CPT, the examination is from the upper esophagus down to and including the GE (gastroesophageal) junction. You can't code the 43191 unless the esophagoscope is advanced all the way down to the GE junction. Most often in these cases, I see the esophagoscope used to examine the proximal esophagus and post laryngeal area and the surgeon doesn't advance the scope all the way down to the GE junction. Just a thought.

This is a really good point, thank you! I will look into this.

jennifer