CPT CODES

CPT Code 31370

CPT code 31370 is for the partial removal of the larynx, a procedure involving the surgical excision of part of the voice box.

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What is CPT Code 31370

CPT code 31370 is used to describe the surgical procedure involving the partial removal of the larynx, also known as a partial laryngectomy. This procedure is typically performed to treat conditions such as laryngeal cancer, where only a portion of the larynx needs to be removed to eliminate the cancerous tissue while preserving as much of the laryngeal function as possible. The goal of this surgery is to maintain the patient's ability to speak and swallow, which can be significantly impacted by more extensive laryngeal surgeries. Proper documentation and coding of this procedure are crucial for accurate billing and reimbursement in the healthcare revenue cycle.

Does CPT 31370 Need a Modifier?

For CPT code 31370, which involves the partial removal of the larynx, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used:

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 apply if there are unforeseen complications or additional work involved in the partial removal of the larynx.

2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the larynx, this modifier would be applicable.

3. Modifier 51 - Multiple Procedures: This is used when multiple procedures are performed during the same surgical session. If the partial removal of the larynx is performed alongside other procedures, this modifier would be appropriate.

4. 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 may be necessary if the partial laryngectomy is performed in conjunction with other procedures that are not typically reported together.

5. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier would be used to indicate the involvement of both surgeons.

6. Modifier 66 - Surgical Team: This modifier is applicable when a highly complex procedure requires the skills of a surgical team, which may be the case for certain partial laryngectomy procedures.

7. Modifier 76 - Repeat Procedure by Same Physician: If the procedure needs to be repeated by the same physician, this modifier would be used.

8. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician, this modifier would be applicable.

9. 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 modifier is used if the patient needs to return to the operating room for a related procedure during the postoperative period.

10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: If an unrelated procedure is performed during the postoperative period of the initial surgery, this modifier would be used.

11. Modifier 80 - Assistant Surgeon: If an assistant surgeon is necessary for the procedure, this modifier would be applicable.

12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is required, and a qualified resident is not available.

These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is important to review the specific details of each case to determine which modifiers are appropriate.

CPT Code 31370 Medicare Reimbursement

The CPT code 31370, which involves a partial removal of the larynx, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines whether a specific CPT code is reimbursable and at what rate. The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals to Medicare beneficiaries.

For CPT code 31370, it is essential to verify its inclusion in the MPFS to confirm its eligibility for reimbursement. Additionally, the reimbursement process is influenced by the Medicare Administrative Contractor (MAC) that services your region. MACs are responsible for processing Medicare claims and have the authority to interpret national policies and make local coverage determinations. Therefore, it is advisable to consult the specific MAC for your area to ensure that CPT code 31370 is covered and to understand any local coverage policies or documentation requirements that may apply.

In summary, while CPT code 31370 can be reimbursed by Medicare, healthcare providers should verify its status on the MPFS and consult their regional MAC for any specific guidelines or requirements.

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