CPT code 31367 is for the partial removal of the larynx, a procedure involving the surgical excision of part of the voice box.
CPT code 31367 is used to describe a surgical procedure involving the partial removal of the larynx, also known as a partial laryngectomy. This procedure is typically performed to treat certain conditions affecting the larynx, such as cancer, by removing only the affected portion while preserving as much of the laryngeal structure and function as possible. The goal is to maintain the patient's ability to speak and swallow, which can be significantly impacted by more extensive laryngeal surgeries. This code is crucial for accurate billing and documentation in the healthcare revenue cycle, ensuring that providers are reimbursed appropriately for the specialized surgical services they deliver.
For CPT code 31367, which involves the partial removal of the larynx, the following modifiers may be applicable depending on the specific circumstances of the procedure and the patient's condition:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was conducted.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons are involved and share responsibility.
5. Modifier 66 - Surgical Team: When a highly complex procedure requires a surgical team, this modifier is used to denote the involvement of multiple professionals.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the procedure on the same day, this modifier is applicable.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a different physician repeats the procedure on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This is used when the patient needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure performed during the postoperative period is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is necessary for the procedure, this modifier indicates their involvement.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is required due to the unavailability of a qualified resident surgeon.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is essential to review the specific payer policies and guidelines to determine the appropriate use of modifiers for each case.
CPT code 31367, which involves a partial removal of the larynx, is subject to reimbursement by Medicare, provided it meets specific criteria outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS is a comprehensive listing of fees used by Medicare to determine payment for services rendered by physicians and other healthcare providers.
However, it's important to note that reimbursement is not solely determined by the MPFS. Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make local coverage determinations (LCDs) that can affect whether a particular CPT code is reimbursed in their jurisdiction. Therefore, while CPT code 31367 is generally reimbursable under Medicare, healthcare providers should verify with their specific MAC to ensure compliance with any local policies or additional documentation requirements that may influence reimbursement.
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