Wiki Trachs during other major and main procedures

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buec02

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Hi all,

I have a surgeon who is adamant about billing a Tracheostomy, planned (separate procedure, 31600) during other major and main procedures like: 31360, 41150, 21045, 21245, and thyroid codes 60220 and on. I have expressed many times it is not appropriate to append a -59 because: same op session, same surg site, using to help ventilate the pt, performed on every single patient (routine standard of care), and to help prevent respiratory obstruction for laryngeal swelling (included in risk of 31360); however he still does not feel these reasons are sufficient, can anyone help?? I would like to present additional information to him as to why this is just not appropriate.

Thanks!!!
 
Have you tried to google other respected opinions, from Zupko, for instance? Also, I used to code for Head and Neck, and I know for certain that the trach is included in the laryngectomy and the hemi-gloss, but I don't recall it being included in the mandible resection or the thyroidectomy. If the physician can prove medical necessity for those, you may be able to bill for it. For instance, if the patient has a potentially compromised airway due to a large compressive, goiter or thyroid nodule, we definitely would bill the trach if one was performed.
 
My concern was that trach itself is a separate procedure; but our billing software does not bundle separate procedures out because you should not be billing separate procedures to begin with (normal circumstances). From my coding experience adding a -59 would be inappropriate.....
 
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