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.

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Can we charge a 31231 and a 30901, 30903, or 30905 if the scope is withdrawn and then the cautery is done?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