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31599 denial from WPS

Melinda Posted Fri 16th of November, 2012 17:10:52 PM

31599 was submitted to WPS Medicare for payment of Laser Removal of supraglottic obstruction with supraglottic and glottic dilations. We received denial from WPS Medicare, I called and spoke to rep and she stated that there were two other CPT codes that could be used to better describe this procedure. I have not been able to determine what those codes could be. I have included Operative Report and appreciate any suggestions.

Operative Report

DIAGNOSIS: Supraglottic obstruction secondary to inflammatory process, probably plasmacytoma.

TITLE OF PROCEDURE:
1. Tracheostomy.
2. Bronchoscopy.
3. Laser Removal of supraglottic obstruction with supraglottic and glottic dilations.

Patient has had previous tracheostomy.

Incision was made. Strap muscles divided in the midline, and scar tissue over the trachea was identified and elevated superiorly and inferiorly. Incision into the trachea was carried out with the removal of orotracheal tube and placement of 4 mm Shiley low-pressure cuff-type tube. This was suture in place with a 0 nylon.

At that time throught the oral cavity, pediatric bronchoscopy carried out through the supraglottic obstruction. True vocal cords could be identified and subglottic region entered with no abnormalities at this point. With the cuff deflated in the trach tube, the scope was inserted below the tracheostomy site. Main stem bronchus was identified and noted to be sharp. Left main stem bronchus was entered, upper and lower divisions seen with no intrinsic lesions noted. Scope removed, and the cuff reinflated.

At that time, Jako laser and direct laryngoscopy scope was inserted and suspended. The stenotic supraglottic area was well visualized and lasered using 4 watt power with continuous current used to start in the proximate area at the aryepiglottic folds below the epiglottis and removed scar tissue. Care was taken as approaching true vocal cords. This was taken down through approximately 1 cm of scar tissue to level of the vocal cords for the visualization of the vocal cords and subglottic area. The Jako scope removed, and 7 mm orotracheal tube was then passed through the supraglottic area and between the vocal cords. Will hope this opening will remain. We will leave the trach tube in somewhat in extended period of time to make sure no problems exist and change over to a metal Jackson tube, so that can be plugged and watch this airway.

SuperCoder Answered Mon 19th of November, 2012 04:45:37 AM

A diagnostic bronchoscopy through an established tracheostomy is normally described by code 31615 (tracheobronchoscopy through established tracheostomy incision).

31528-is used for dilation of larynx.
Use 31540 to remove scar tissue. These 2 codes are far better than unlisted ones.Method the physician can use is to simply excise (using a scalpel, laser, or other such tool) the vocal cord scar instead.

Plasmacytoma is itself a malignant plasma cell tumor.

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