Bronchoscopy with Direct Laryngoscopy

Question:

I’m trying to figure out when I can bill for both a direct laryngoscopy and a bronchoscopy.  It seems very confusing so I would appreciate it if you could help.

Answer:

Sure!  CPT 31622 (diagnostic bronchoscopy) may be separately reported when both of these criteria are met: 1) a separate piece of equipment, other than that used for the direct laryngoscopy, is used, and 2) the scope entered the right and/or left bronchus. If neither criteria is met, then 31622 is not separately reported.  It goes without saying that you must have established medical necessity for the procedure (e.g., diagnosis statements, Indications paragraph).

*This response is based on the best information available as of 8/19/21.

Does Type of Scope – Rigid or Flexible – Matter for Coding?

Question:

Does 31231 (nasal endoscopy) have to be done with a rigid scope?

Answer:

The CPT descriptor for 31231 is: Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure). Notice it does not specify whether the scope must be rigid or flexible. That said, CPT makes it clear that the anatomic structures examined in 31231 include the interior of the nasal cavity and the middle and superior meatus, the turbinates, and the sphenoethmoid recess.

Question:

Does 92511 (nasopharyngoscopy) require use of a flexible scope?

Answer:

CPT does not specify what type of scope is used for 92511 (Nasopharyngoscopy with endoscope (separate procedure)).  You could use a rigid or flexible scope.  The most important aspect of 92511 is the anatomic structure(s) examined which would include the nasal cavity, nasopharynx (e.g., adenoids) and Eustachian tube openings.

Question:

Does 31575 (laryngoscopy) require the use of a flexible scope?

Answer:

Yes. The CPT descriptor is “Laryngoscopy, flexible; diagnostic.”  Notice the word “flexible” is in the code language.

*This response is based on the best information available as of 05/27/21.

Procedure with Spine Surgeon

Question:

I was asked, by a new spine surgeon in town, to do the cervical approach for an anterior cervical decompression and fusion.  Do I use a regular neck dissection code such as 38724?

Answer:

Oh no, 38724 is for a modified radical neck dissection requiring removal of lymph nodes.  The cervical approach is actually included in the spine surgeon’s ACDF code.  This means you’ll both bill the same code, probably 22551, with modifier 62 (two surgeons or co-surgery).  Use +22552-62 for each additional level for which you do the cervical approach.

*This response is based on the best information available as of 03/04/21.

Bjork Flap Tracheostomy

Question:

What would the correct CPT code be for a tracheostomy performed using a Bjork flap? I see some people stating it should be 31610. However, a Bjork flap is technically not a skin flap. I thought CPT 31610 was more for when a permanent stoma is created.

Answer:

CPT 31600 is the correct code for a Bjork flap tracheostomy. You are correct that 31610 is for a permanent tracheostomy where skin flaps are used to create a permanent stoma.

*This response is based on the best information available as of 10/15/20.

Lymph Node Biopsy

Question:

I took out 3 deep cervical nodes for biopsy on the left side. Can I bill 38510 x 3?

Answer:

No – you’d report 38510 once for any number of nodes removed from the same incision.

*This response is based on the best information available as of 07/09/20.

Intraoperative Laryngeal Nerve Monitoring with Thyroidectomy Procedures

Question:

Are we able to bill for laryngeal nerve monitoring with thyroidectomy procedure?

Answer:

No – CPT is very clear in that intraoperative monitoring (e.g., 95940, 95941) is included in the global surgical package for the surgeon and should not be separately reported.

*This response is based on the best information available as of 06/11/20.