General Surgery Coding Alert

Add lesion ablation and other specific procedure choices.

When your surgeon performs a flexible laryngoscopy with therapeutic injection next year, you’ll finally have a specific code to report the service (31573). The new code is part of an update of the flexible laryngoscopy family that revises the four existing codes and adds three new ones.

That’s not all: CPT^® 2017 also updates the Laryngoplasty codes with revisions, deletions, and additions that you need to know. Read on to let our experts guide you in how to report these procedures beginning January 1.

Don’t Look for ‘Fiberoptic’ Restriction

The common part of the flexible laryngoscopy procedure descriptor changes in 2017 to drop the term “fiberoptic” from the definition, as follows:

• 31575 — Laryngoscopy, flexible fiberoptic; diagnostic

That means all of the codes in this family share the “laryngoscopy, flexible” description without confining the codes to fiberoptic methodology. “Although most procedures using a flexible laryngoscope continue to use fiberoptic technology, that’s not always the case, so the revised codes will now apply even if the laryngoscope uses other visualization techniques,” says Marcella Bucknam, CPC, CPC-I, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, internal audit manager with PeaceHealth in Vancouver, Wash.

CPT^® 2017 also revises the existing flexible laryngoscopy codes to account for multiple specimens, as follows (strike through means the text is deleted, underline means the text is new in 2017):

• 31576 — … with biopsy (ies)
• 31577 — … with removal of foreign body(s)
• 31578 — … with removal of lesion(s), non-laser

You’ll also find the following three new codes to describe other specific therapeutic procedures that your surgeon might perform as part of a flexible laryngoscopy:

• 31572 — … with ablation or destruction of lesion(s) with laser, unilateral
• 31573 — … with therapeutic injection(s) (e.g., chemodenervation agent or corticosteroid, injected percutaneous, transoral, or via endoscope channel), unilateral
• 31574 — … with injection(s) for augmentation (e.g., percutaneous, transoral), unilateral.

Distinguish codes: Flexible laryngoscopy is different from direct laryngoscopy procedures that you should report with codes in the range 31515-31571 (Laryngoscopy, direct …). Surgeons typically perform the latter procedures in the operating room under anesthesia, while they generally perform flexible laryngoscopy in the office using topical anesthetics rather than sedation or general anesthesia.

Also, you may see the flexible laryngoscope identified as “nasal pharyngeal laryngoscopy (NPL)” if the approach is through the nose rather than the mouth. In those cases, you’ll need to further distinguish 31572-31578 from 31231-31297 (Nasal… endoscopy…) by ensuring that the surgeon documents examination and procedure(s) involving the larynx, not just the nasal passages and sinuses.  

Beware E/M: If your surgeon performs a flexible laryngoscopy in the office, you may be tempted to bill a separate E/M. But you should not separately report the small E/M performed as part of a scheduled scope procedure.

However, if the physician performs a scheduled office-visit E/M, then decides to perform a medically-necessary flexible laryngoscopy at the same session based on the findings, you can code both procedures by using modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service).

“Documentation needs to show that the scope was not planned and a decision to perform it was made based on the manual exam of the specific anatomy that applies,” says Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, vice president at Stark Coding & Consulting, LLC, in Shrewsbury, N.J. “That helps justify appending modifier 25 to the E/M code.”

Re-Work Laryngoplasty Coding

If your surgeon performs any open larynx repair procedures, you’ll need to know about revisions, deletions, and additions to codes in the range 31580-31592 for CPT^® 2017.

Replace with new codes: For laryngeal stenosis repair, you’ll no longer report 31582 (Laryngoplasty; for laryngeal stenosis, with graft or core mold, including tracheotomy) in 2017, because CPT^® deletes the code. In its place, you’ll find the following four new codes to choose from (listed with # in the CPT^® book because they’re out of numerical sequence):

• 31551 — Laryngoplasty; for laryngeal stenosis, with graft, without indwelling stent placement, younger than 12 years of age
• 31552 — … for laryngeal stenosis, with graft, without indwelling stent placement, age 12 years or older
• 31553 — … for laryngeal stenosis, with graft, with indwelling stent placement, younger than 12 years of age
• 31554 — … for laryngeal stenosis, with graft, with indwelling stent placement, age 12 years or older

Replace NOS: CPT^® 2017 deletes 31588 (Laryngoplasty, not otherwise specified [e.g., for burns, reconstruction after partial laryngectomy]), but reduces your need for the code by revising and adding codes to provide specific options to report your surgeon’s laryngoplasty work. Look at the following revisions:

• 31580 — Laryngoplasty; for laryngeal web, 2-stage, with indwelling keel insertion and removal or stent insertion
• 31584 — … with open reduction and fixation of (e.g., plating) of fracture, includes tracheostomy, if performed
• 31587 — … cricoid split, without graft placement

For other specific laryngoplasty procedures, you should also prepare to use the following new codes in 2017:

• 31591 — Laryngoplasty, medialization, unilateral
• 31592 — Cricotracheal resection

Now that you no longer have 31588 as a code option, if your surgeon performs a laryngoplasty procedure that one of the new or revised codes doesn’t describe, you’ll need to turn to 31599 (Unlisted procedure, larynx).