How To Use CPT Code 31766

CPT 31766 describes the procedure of carinal reconstruction, which involves the removal of a tumor from the carina and the subsequent reconstruction of the carina through anastomosis. This article will provide an overview of CPT code 31766, including its official description, the procedure involved, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 31766?

CPT 31766 is a code used to describe the surgical procedure of carinal reconstruction. This procedure is performed when a tumor is present in the carina, which is the ridge of cartilage within the trachea that separates the two primary bronchi. The provider removes the tumor and then reconstructs the carina through anastomosis, which involves joining the main bronchus or both bronchi to the lower trachea. The surgical approach may vary depending on the specific resection performed by the provider.

2. Official Description

The official description of CPT code 31766 is: ‘Excision and repair procedures on the trachea and bronchi, carinal reconstruction.’

3. Procedure

1. The patient is placed under anesthesia and positioned in the supine position.
2. The provider makes an incision in the trachea to access the carina.
3. The tumor of the carina is excised or resected.
4. The provider then reconstructs the carina through anastomosis, joining the main bronchus or both bronchi to the lower trachea.
5. The surgical approach may vary depending on the specific resection performed by the provider.

4. Qualifying circumstances

Carinal reconstruction is considered an aggressive treatment for tumors of the carina. This procedure is performed on patients who have tumors in the carina that require surgical removal and subsequent reconstruction. The provider must assess the patient’s condition and determine that carinal reconstruction is necessary. The procedure is typically performed by a qualified surgeon with expertise in tracheal and bronchial surgeries.

5. When to use CPT code 31766

CPT code 31766 should be used when a provider performs carinal reconstruction, which involves the excision of a tumor from the carina and the subsequent reconstruction of the carina through anastomosis. This code is appropriate when the procedure is performed on the trachea and bronchi, specifically for carinal reconstruction. It is important to note that CPT code 31766 should not be used for other types of tracheal or bronchial procedures.

6. Documentation requirements

To support a claim for CPT code 31766, the provider must document the following information:

• Patient’s diagnosis and the need for carinal reconstruction
• Description of the specific procedure performed, including details of the tumor excision and carinal reconstruction
• Date of the procedure
• Any additional relevant information, such as the surgical approach used
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 31766, ensure that the procedure performed is carinal reconstruction and not another type of tracheal or bronchial procedure. It is important to accurately document the details of the procedure and provide any necessary supporting documentation. CPT code 31766 should not be reported with other codes unless additional procedures were performed during the same surgical session that are separately reportable. It is essential to follow the specific billing guidelines provided by the payer to ensure proper reimbursement.

8. Historical information

CPT code 31766 was added to the Current Procedural Terminology system on January 1, 1990. The code has not undergone any updates since its addition. In 2017, it was added to the Inpatient Only (IPO) list for Medicare reimbursement purposes.

9. Similar codes to CPT code 31766

Five similar codes to CPT code 31766 include:

• CPT 31750: Excision and repair procedures on the trachea and bronchi, segmental resection
• CPT 31751: Excision and repair procedures on the trachea and bronchi, sleeve resection
• CPT 31755: Excision and repair procedures on the trachea and bronchi, laryngotracheal reconstruction
• CPT 31760: Excision and repair procedures on the trachea and bronchi, tracheal reconstruction
• CPT 31830: Excision and repair procedures on the trachea and bronchi, bronchoplasty

9. Examples

1. A patient undergoes carinal reconstruction to remove a tumor from the carina and reconstruct the carina through anastomosis.
2. A surgeon performs carinal reconstruction on a patient with a malignant tumor in the carina.
3. Carinal reconstruction is performed on a patient with a benign tumor in the carina to alleviate symptoms and improve respiratory function.
4. A provider performs carinal reconstruction on a patient with a recurrent tumor in the carina after previous treatment.
5. A patient undergoes carinal reconstruction as part of a comprehensive treatment plan for a complex tracheal and bronchial condition.
6. Carinal reconstruction is performed on a patient with a carinal tumor that is causing airway obstruction.
7. A surgeon performs carinal reconstruction on a patient with a carinal tumor that is suspected to be malignant.
8. Carinal reconstruction is performed on a patient with a carinal tumor to improve their quality of life and respiratory function.
9. A provider performs carinal reconstruction on a patient with a carinal tumor that is causing recurrent infections.
10. A patient undergoes carinal reconstruction to remove a tumor from the carina and restore normal airway function.