Sharon Posted Thu 10th of November, 2011 19:42:38 PM
Please help with Px codes. I am thinking 31528 and 31526, but not sure about the others. Op note:
1. Direct laryngoscopy with microscopic evaluation and microscopic biopsy of subglottic stenosis.
2. Laser excision of subglottic stenosis.
3. Dilation subglottic stenosis with balloon.
After adequate anesthesia was accomplished, visualization of the cords is undertaken with a direct laryngoscope, Dedo shape, with laser coating. The Dedo laryngoscope was then positioned for exposure of the subglottis. It was passed gently through the cords and visualized is the altered anatomy, particularly of the right side. The altered anatomy consists of 2 pockets, one anterior and one midway, that is visualized on the preoperative pictures on bronchoscopy and then a clearcut large very thick web to the 4:00 to 5:00 position. Next, injection of areas of concern in order to facilitate improved healing as well as to facilitate the laser resection. This is at the 4:30 position and then up at 1:30. The 1:30 position is also accompanied by the more superior or cephalad pockets which were palpated with a right angle probe. Debris notable in one of the posterior pockets and this is sent off for biopsy and an additional biopsy after incising the mucosa is also undertaken to rule out granulomatous disorder. These 2 incisions were then taken down to the level of the tracheal cartilage and then demonstrating marked improvement in the airway, a balloon dilator was likewise used and taken up to 4 atmospheres and 14 mm in size. This is an Acclarent endotracheal balloon for tracheal dilation. This was left for a period of 20 seconds. Throughout the case, jet ventilation is accomplished through an external pilling adaptor. No need for the Hunsaker type tube throughout the case as well. Hemostasis was obtained with both the laser on a D focus beam as well as cutting beam used and then Afrin pledgets.
SuperCoder Answered Fri 11th of November, 2011 14:52:42 PM
In addition to the two codes you mentioned you have bill as follows:
A separate CPT code does not exist for laser laryngoscopic surgery. The code for the equivalent surgical procedure without the laser is employed.
You need to use the CPT 31599 (Unlisted procedure, larynx), and bill it with an equivalent CPT 31781 (Excision tracheal stenosis and anastomosis; cervicothoracic)