Otolaryngology Coding Alert

E/M codes now the choice for closed laryngeal fracture care

You should no longer turn to 31585 or 31586 for  treatment of a closed larynx fracture.

CPT 2006 has deleted these codes without creating any new, specific codes to replace their function. Instead, you should report an appropriate-level E/M service code for procedures of this type, CPT guidelines say.

Rationale: The AMA deleted 31585 and 31586 for 2006 -because these codes simply weren't getting used,- says Charles F. Koopmann Jr., MD, MHSA, professor and associate chair at the University of Michigan's department of otolaryngology in Ann Arbor.

Example: The ENT examines the fractured larynx with an operating laryngoscope. He observes no mucosal tears and palpates the exterior laryngeal area while visualizing the glottic area directly. He then applies a semi-rigid, circumferential dressing to protect the larynx.

CPT instructions and the elimination of 31585 mean you must report an E/M code for this service. If this is a new patient who arrived at the request of a primary-care physician (in other words, for a consultation), for instance, you would report an appropriate code from the office or other outpatient consultation series (99241-99245), as appropriate to the level of documentation the physician provides.

What about the scope? Although CPT does not specifically instruct you, if the ENT uses a laryngoscope to examine the larynx (for example, 31575, Laryngoscopy, flexible fiberoptic; diagnostic; or 31525, Laryngoscopy direct, with or without tracheoscopy; diagnostic, except newborn), you should be able to report the scope in addition to the E/M service, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.

Be sure to provide documentation that supports the separate nature of the E/M service, and be sure to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the appropriate E/M service code.

Say -Goodbye- to 2 More

Two more codes you-ll have to do without in 2006 are 42325 and 42326. These codes formerly described creation of salivary cyst drain, but they have also been eliminated because of infrequent use.

CPT provides no specific instruction on how to report creating salivary cyst drain, if necessary. Therefore, the best choice for these procedures becomes 42699 (Unlisted procedure, salivary glands or ducts), Cobuzzi says.