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.

Nasal Endoscopy and Epistaxis Control

Question:

Can we charge a 31231 and a 30901, 30903, or 30905 if the scope is withdrawn and then the cautery is done?

Answer:

No.  CPT 31231 is a diagnostic procedure and includes the parenthetical statement “separate procedure.”  That means 31231 is included in a more definitive therapeutic/treatment procedure at the same operative session.  Report either CPT code 31231 or 30901 (or 30903 or 30905), but not both codes.

*This response is based on the best information available as of 05/28/20.

Coding Both Dix-Hallpike and the Epley Maneuver

Question:

I billed 95992 (Epley) and 92532 for the Dix-Hallpike I did. I got paid for 95992 but not 92532. Should I have used a modifier to get paid and should we appeal the denial?

Answer:

No. CPT 92532 is for positional nystagmus testing without a recording such as what you did for a Dix-Hallpike maneuver. CPT allows coding both 95992 and 92532 together. That said, Medicare, and most payors, consider this service included in the E/M or other service (95992) code you reported and not separately payable. .

We consider the performing the Dix-Hallpike, without a permanent recording, to be part of the exam performed and not separately billable. We do not recommend appealing the denial.

*This response is based on the best information available as of 02/20/20.

Ear Exam Under Anesthesia

Question:

Our surgeon performed an evaluation of the external ear canal on a pediatric patient, under general anesthesia, because the child would not allow the surgeon to evaluate the ears thoroughly in the office. We cannot find a CPT code for this service. Do we use an unlisted code?

Answer:

CPT code 92502, (Otolaryngologic examination under general anesthesia) describes a complete ENT exam under general anesthesia. If only the ears were examined, then modifier 52 (reduced services) would be appended to indicate an entire otolaryngologic examination was not performed.

*This response is based on the best information available as of 01/23/20