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Otolaryngology Coding Alert

Recognize Key Words to Bill Effectively for Laryngoscopy Procedures

- Published on Sun, Oct 01, 2000
Using the wrong laryngoscopy code can be a costly error. A relatively simple procedure such as an indirect laryngoscopy (where no scope is used) can be confused with a far more complicated surgery because both codes describe laryngoscopies, with little in the CPT manual to distinguish them.

In fact, CPT lists 27 distinct laryngoscopy codes. Because there are so many, confusion about which code to use can occur, particularly if the otolaryngologist simply lists laryngoscopy at the top of the operative note. As a result, coders need to check the otolaryngologists documentation carefully not just the description of the procedure at the top of the operative report. This will ensure that the procedure performed will be the one billed.

Laryngoscopy Code Groups

The 27 codes can be divided into the following three groups:

indirect laryngoscopy
direct laryngoscopy
flexible laryngoscopy

Each of these groups, further, consists of four or more codes that differ by function, including but not limited to the following criteria:

with biopsy
with removal of foreign body
with removal of lesion

The reimbursement rates for these procedures vary greatly. For example, a diagnostic indirect laryngoscopy (31505, laryngoscopy, indirect; diagnostic [separate procedure]) has an assigned value of 2.14 relative value units (RVUs). A direct scope with arytenoidectomy (31561, laryngoscopy, direct, operative, with arytenoidectomy; with operating microscope), the most expensive of the laryngoscopy procedures, has an assigned value of 9.90 RVUs.

This range of codes and corresponding payment rates means coders need to know how the three main laryngoscopy categories differ from each other. Further, coders need to
know how to recognize key words in the otolaryngologists operative report that point not only to the correct category but also to the specific procedure performed.

Indirect Laryngoscopy

Indirect laryngoscopy is the simplest of the three laryngoscopy categories. Consequently, the five procedures in this category do not involve a scope and offer the least reimbursement. Rather, they are used when the otolaryngologist examines the patient using mirrors to visualize the larynx, either for diagnostic purposes or as a guide for biopsy, lesion or foreign body removal, or vocal cord injection.

The simplest of these codes (diagnostic) often is used during a routine examination and should not be billed separately, says Barbara Cobuzzi, MBA, CPC, CPC-H, an independent coding and reimbursement specialist in Lakewood, N.J.

If the mirror is used to check on a specific condition or symptom, however, it may be billed separately. For example, a patient visits the doctor because of an earache (381.01, acute serous otitis media) but also complains of a sore tongue. The otolaryngologist evaluates the tongue using the mirror and determines the patient has glossitis (529.0).

Because the mirror exam is unrelated to [...]

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