# Failed laryngeal function study



## btadlock1 (Jan 4, 2011)

I don't have a note with a specific example, but I'm trying to modify a template used for Sleep Study referrals...What ICD-9 would you use to indicate that a patient failed a laryngeal function study?

I came up with 478.79 (Obstruction of larynx), but I'm not happy with it...

Thanks!


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## btadlock1 (Jan 4, 2011)

*Okay, I look stupid replying to my own post, but...*

I changed my mind after looking some more - I now think that 794.19 is the best choice...Non-specific abnormal results of function studies, Peripheral nervous system and special senses, Other.


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## msrd_081002 (Jan 5, 2011)

btadlock1 said:


> I changed my mind after looking some more - I now think that 794.19 is the best choice...Non-specific abnormal results of function studies, Peripheral nervous system and special senses, Other.



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"failed laryngeal study" can *imply either*
Procedure failure or (WO achieving desired result)
Complication arising from px &* 
ICD 'd be according*ly (insuficient query documentation, need additional)

The point is -If px is "performed successfully" WITH an "abnormal result", then I'd code 794.9 (Without any definitive dx)*+ *symptoms indicating

My explanation:

laryngeal function study is: (We'll assign 92520 cpt
The physician inserts a laryngoscope through the mouth or nose to examine the larynx. An indirect laryngoscope uses mirrors to view the larynx, while a direct laryngoscope is done with a fiberoptic scope. The function studies are used to diagnose the reason for laryngeal dysfunction such as swallowing disorders, chronic hoarseness, or an obstruction. 
*
If physician mentions only " an ABNORMAL finding from laryngeal function study", I'd assign 794.9.*
Finding/function study *other specified-*794.9 (Without any definitive dx)

Thanks


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## btadlock1 (Jan 5, 2011)

I was referring to a study that was performed properly, with abnormal patient results, resulting in a referral for a polysomnography. The reason I opted to go with 794.19 rather than anything else was basically due to a process of elimination...
794.9 Indicated examples of Function studies such as Bladder, Pancreas, Placenta, and Spleen, which didn't seem to fit with the larynx, or the nature of the study, so I decided against it. 

I also ruled out 794.2, Pulmonary, because it's not really the lungs, either. That left me with 794.09 and 794.19. Since the larynx isn't part of the brain or central nervous system, I immediately ruled out 794.09. I was left with peripheral nervous system and special senses, which included things such as visual funct., auditory funct., skeletal muscular-electrical activity, and balance. The laryngeal function study just seemed to fit better with those than with the organ systems whose function has to be assessed through nuclear medicine and CT scans.  

I'm not saying that I'm certain my choice is correct, but I don't understand why it wouldn't be an applicable code in this situation. What are your thoughts?

I have to understand where I went wrong, so I could use someone else's viewpoint...Thanks!


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## ohn0disaster (Jan 5, 2011)

I agree with msrd's code selection of 794.9. 

My reasoning is that 794.1X code range is dealing with the peripheral nervous system, consisting of nerves and ganglia outside of the brain and spinal cord connecting the central nervous system to the limbs and organs, and the 'special senses'. Your special senses being vision, sound, balance, smell, and taste. 

Although the code 794.9 does not mention exactly what you are looking for, I feel this is the best fit, as it is a general code for all '*other*' function studies that may not fit elsewhere. It could go on to mention all intended to fall under *other*, but that could be a long list!

Just my 2 cents.


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## btadlock1 (Jan 5, 2011)

I may not be looking at the right thing, but all of the research I've found seems to indicate that the larynx is highly integrated with the peripheral nervous system, just as much as hearing and sight...here's a clip from one website:
Location (Areas 44, 45)
Located in the inferior frontal gyrus. 
*Function* Responsible for innervation of the musculature for speech (the larynx, tongue and lips) on the dominate hemisphere known as Broca's Speach area. On the non-dominate hemisphere, these areas deal with reflexive speech. 
*Input *In the dominant hemisphere receives information from Area 40 on the dominant hemisphere, and the pre frontal cortex (9-10-11-12). On the non-dominant hemisphere information is also received from areas 19, 41, 42, 43 and 1-2-3. 

http://faculty.quinnipiac.edu/health/tantorski/Unit7/unit7.html

There were lots of other pages, but this one was the easiest for a non-neurologist to interpret. 

So I'm back to my original question...could it not be considered "Other specified" under the peripheral nervous system?


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## msrd_081002 (Jan 6, 2011)

*MAIN THREE DIGIT RUBRIC 794-{794.0 -"794.9"}/Subcategory "794.19"*

So I'm back to my original question...could it not be considered "Other specified" under the peripheral nervous system?
Brandi Tadlock, CPC, CPMA 
-------------------------------------------------------------------------------------------------------
Answer is NO. Here is my explanation.Pls go through the TABULAR FORMAT CONVENTIONS

MAIN THREE DIGIT RUBRIC 794
FURTHER indented beneath with *expanded 4 rth digit*-- 794.1-*794.9* MY CHOICE refers to this
still further "*EACH*" SUB categorized into (indented beneath/*expanded to 5 digit*) 794.00-794.09; 794.10-794.19; YOU 'RE REFERING TO THIS LEVEL "EXCLUSIVELY REFERS TO 794.1 SUBCATEGORY ONLY. "

YOUR choice of 794.19 "*OTHER*" mentioned under the subcategory 794.1 *REFERS TO ONLY & ONLY that SUBcategory ie., PERIPHERAL NERVOUS SYSTEM AND SPECIAL SENSES* 
******Pls refer 277 page volume 1 Tab index

Let me explain you with an example:
We usually encounter abnormal bone scan. It is coded to 794.9 

Please look up finding/SCAN/BONE-794.9-----REFERS TO "OHER SPECIFIED". It refers to "other specified" under 794 Nonspecific abnormal results of function studies. 
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similarly--(pls look up vol 1 *285 p*g)
We'll take Fracture of humerus eg
812.0x UPPER END closed
----812.00
----812.01
---812.02
---812.03
---812.09 OTHER ONLY REFERS TO "UPPER END closed" 812.0X
-------------
812.4x LOWER END closed
---812.40
---812.41
---812.42
---812.43
---812.44
---812.49 OTHER REFERS TO "LOWER END closed" 812.4X only



Thanks


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## btadlock1 (Jan 6, 2011)

msrd_081002 said:


> So I'm back to my original question...could it not be considered "Other specified" under the peripheral nervous system?
> Brandi Tadlock, CPC, CPMA
> -------------------------------------------------------------------------------------------------------
> Answer is NO. Here is my explanation.Pls go through the TABULAR FORMAT CONVENTIONS
> ...



Okay, first of all, chill out - I'm not attacking you, here, so all of the written yelling isn't necessary...Please be patient with me, I know my ignorance must be frustrating, but what I'm asking is, how have you determined that the laryngeal function is NOT attributed to the peripheral nervous system and special senses? I'm fully aware that I'm assigning a specific sub-category - I intend to. As I mentioned before, the research that I've been able to find seems to indicate that the laryngeal function is an aspect of the peripheral nervous system, just like sight and hearing and the other functions tied to those. If it's not, then fine - I just need to figure out what I'm not understanding about the physiological attributes of the larynx.


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