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Coding Quiz: Whip Your Laryngoscopy Reporting Into Shape

Find out if you have the know-how when coding isn't clear-cut

Having trouble finding the right codes for laryngoscopies and accompanying procedures? See if you can correctly answer these questions about how and when to bill the 31505 series.
 
Question #1: The physician removes a benign neoplasm from a patient's mucosa. Then she resects the submucosa and places an autograft. Which code should I report for this procedure?

Answer: The appropriate code to describe this scenario is the newly minted 31546 (Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion[s] of vocal cord; reconstruction with graft[s] [includes obtaining autograft]).
Now that this year's CPT additions for laryngoscopy codes (31505-31579) offer specific procedural details that distinguish among indirect, direct or flexible laryngoscopies, you can look over the description of the procedure at the top of the physician's operative report, instead of sifting through every detail in the record, which makes reporting the correct code easier.
These new codes came about because physicians thought the old laryngoscopy codes didn't accurately describe the work they were doing, says Steve Peters, a critical care medicine consultant at the Mayo Clinic in Rochester, Minn.
These codes cover the physician's work to obtain the autogenous graft within the basic surgical procedure, says Roger Hettinger, CPC, CMC, CCS-P, coding specialist with Sioux Valley Clinic in Sioux Falls, S.D.
Question #2: May I bill a laryngoscopy and a videostroboscopy for a patient complaining of hoarseness?

Answer: Even though the physician may insert one scope and then another, you should bill only for the strobovideolaryngoscopy (31579, Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy). The doctor performs 31575 (Laryngoscopy, flexible fiberoptic; diagnostic) and 31579 for the same reason and to examine the same area.
Both the videostroboscopy and the laryngoscopy examine the larynx. The videostroboscopy also allows the physician to assess vocal-cord function. The diagnostic laryngoscopy leads the doctor to use a flexible or rigid laryngoscope equipped with a light strobe to better visualize the vocal cords. Thus, 31579 is a more extensive procedure than 31575. Since the videostroboscopy includes the initial diagnostic procedure, reporting 31575 in addition to 31579 is redundant.
Question #3: Is it correct to report 31541 if instead of using the microscope, the physician uses the telescope for the procedure?

Answer: CPT anticipates changing 31541's descriptor from "Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope" to "... with operating microscope or telescope." But the code doesn't now include the telescope technique.
 
Whether you should now apply the possible editorial change depends on the payer. Some intermediaries may consider using 31541 for telescopic use appropriate. Others may have a stricter interpretation [...]

- Published on 2005-03-22