CPT CODES

CPT Code 31375

CPT code 31375 is for the partial removal of the larynx, used by healthcare providers to document and categorize this specific medical procedure.

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What is CPT Code 31375

CPT code 31375 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 conditions such as laryngeal cancer, where only a portion of the larynx is affected and can be safely removed while preserving as much of the laryngeal function as possible. The goal of this surgery is to eliminate the diseased tissue while maintaining the patient's ability to speak and swallow. This code is essential for healthcare providers to accurately document and bill for the procedure, ensuring appropriate reimbursement and tracking of healthcare services.

Does CPT 31375 Need a Modifier?

For CPT code 31375, which involves the partial removal of the larynx, the following modifiers may be applicable depending on the specific circumstances of the procedure:

1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.

2. Modifier 50 - Bilateral Procedure: If the procedure is performed bilaterally, this modifier indicates that the procedure was performed on both sides of the body.

3. Modifier 51 - Multiple Procedures: This is used when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was performed.

4. Modifier 52 - Reduced Services: This modifier is applicable when a service or procedure is partially reduced or eliminated at the physician's discretion.

5. Modifier 53 - Discontinued Procedure: This is used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.

6. 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.

7. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure, each surgeon should report the procedure with this modifier.

8. Modifier 66 - Surgical Team: This is used when a complex procedure requires the services of a surgical team.

9. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same physician repeats a procedure on the same day.

10. Modifier 77 - Repeat Procedure by Another Physician: This is used when a procedure is repeated by another physician on the same day.

11. 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 when a patient requires a return to the operating room for a related procedure during the postoperative period.

12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This is used when a procedure is performed during the postoperative period of another procedure, but it is unrelated to the original procedure.

These modifiers help provide additional information about the circumstances of the procedure and ensure accurate billing and reimbursement. Proper documentation is essential when using modifiers to support the necessity and appropriateness of their use.

CPT Code 31375 Medicare Reimbursement

CPT code 31375, which involves a partial removal of the larynx, is subject to reimbursement by Medicare, but several factors influence this process. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines the reimbursement rates for services covered under Medicare Part B. To ascertain if CPT code 31375 is reimbursed, healthcare providers should consult the MPFS to verify its inclusion and the associated payment rate.

Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to establish local coverage determinations (LCDs) that may affect the reimbursement of specific CPT codes. Providers should check with their respective MAC to ensure that CPT code 31375 is covered in their region and to understand any specific documentation or medical necessity requirements that may apply.

In summary, while CPT code 31375 can be reimbursed by Medicare, providers must verify its status on the MPFS and consult their MAC for any regional coverage nuances to ensure proper reimbursement.

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