CPT CODES

CPT Code 31390

CPT code 31390 is for the surgical removal of the larynx and pharynx, often performed to treat severe throat conditions or cancer.

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What is CPT Code 31390

CPT code 31390 is a medical billing code used to describe the surgical procedure for the removal of both the larynx and the pharynx. This procedure, often referred to as a total laryngopharyngectomy, is typically performed to treat advanced cancers of the larynx or pharynx. The surgery involves the complete excision of these structures, which are critical for breathing, speaking, and swallowing. As a result, this procedure is complex and requires significant post-operative care and rehabilitation to help the patient adapt to changes in these functions. In the context of healthcare revenue cycle management, accurate coding of such procedures is crucial for proper billing and reimbursement from insurance providers.

Does CPT 31390 Need a Modifier?

For CPT code 31390, which involves the removal of the larynx and pharynx, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and their purposes:

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 51 - Multiple Procedures: This is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.

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

4. 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.

5. 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.

6. Modifier 62 - Two Surgeons: This is applicable when two surgeons work together as primary surgeons performing distinct parts of a procedure.

7. Modifier 66 - Surgical Team: This is used when a complex procedure requires the services of several physicians, often of different specialties, working together as a team.

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 a related procedure is performed during the postoperative period of the initial procedure.

9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This is used when an unrelated procedure is performed by the same physician during the postoperative period.

These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Proper documentation is essential when using these modifiers to justify their application.

CPT Code 31390 Medicare Reimbursement

CPT code 31390 is subject to reimbursement by Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific policies of the Medicare Administrative Contractor (MAC) in your region.

The MPFS provides a list of services covered by Medicare and assigns a relative value to each service, which is used to determine reimbursement rates. However, MACs have the authority to interpret national Medicare policies and may have additional local coverage determinations that affect reimbursement.

Therefore, it is essential to verify with your local MAC to ensure that CPT code 31390 is covered and to understand any specific documentation or pre-authorization requirements that may apply.

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