Anesthesia Coding Alert

Question: When doing a direct fiberoptic laryngoscopy (31575, laryngoscopy, flexible
fiberoptic; diagnostic), can I bill for administering a topical anesthesia spray? And since I videotape the procedure, can I bill for the recording (audiovisual supplies and equipment)?

New York Subscriber

Answer: Actually, the topical spray would not be billable separately. It is not enough anesthesia to bill with modifier -47 (anesthesia by surgeon) which rarely gets paid anyway and does not meet the qualifications of conscious sedation. Videotaping is generally a non-covered service; Medicare has specific policies that bundle videotaping into the procedure performed.You could bill some carriers for the videotaping using an unlisted code (such as 31599, unlisted procedure, larynx), but you will have to submit a report and probably have to appeal a denial from the carrier. Some physicians will videotape procedures such as arthroscopy on knees and ankles for patients. Usually, the patient provides the videotape and there is no charge for the taping. Some physicians charge a nominal fee, and some facilities may require a minimal charge, but this is billable to the patient, not the insurance company.