Otolaryngology Coding Alert

Reviewed on May 21, 2015

Key differences help you decide whether surgeon performed nasopharyngoscopy

Before you assign CPT 92511 to all of your ENT's flexible diagnostic nasopharyngoscopy procedures, double-check that documentation. Depending on the scope's journey and final destination, you could be miscoding your physician's claims, leaving you open to OIG scrutiny.
 
Although otolaryngologists and coders consider 31575 (Laryngoscopy, flexible fiberoptic; diagnostic) the more extensive procedure, you-ll actually collect about $20 more when you report 92511 (Nasopharyngoscopy with endoscope [separate procedure]). Therefore, if you incorrectly assign 92511 to your laryngoscopy claims, you could be accused of upcoding.
 
And on the flipside, if you erroneously report 31575 when the nasopharyngoscopy code is more appropriate, you-re leaving money on the table.
 

Resolve the Predicament at Last

To determine whether 92511 is appropriate and when you should choose 31575 instead, you should get to know the anatomy that distinguishes the larynx from the nasopharynx.
 
-Nasopharyngoscopy (92511) is an exam of the nasopharynx only,- says John Fink, MD, an otolaryngologist at Dearborn Ear, Nose and Throat in Michigan. -Flexible laryngoscopy (31575) is an exam of the larynx. Generally you have to pass through the nasopharynx, the pharynx and supraglottis/hypopharynx to get in position for an exam of the laryngeal area.-
 
Therefore, if you come across documentation of the physician examining the nasopharynx only, you-ll know that 92511 is the right code.
 
For example: The physician documents the following in his note: Indirect laryngoscopy had failed to provide adequate visualization of the endolaryngeal area due to gag reflex/anatomical features.
 
Flexible laryngoscopy was therefore performed on the endolaryngeal area to evaluate the patient's symptoms. After application of anesthesia, the flexible laryngeal endoscope was introduced into the patient's nasal passageway and advanced under direct visualization.
 
The endoscope was advanced along the floor of the nose and into the nasopharynx. In the nasopharynx, the endoscope was directed inferiorly into the oropharynx and supraglottis. The examination was performed during quiet respiration, with a sniff maneuver and with phonation. The endoscope was removed under direct visualization. The patient tolerated the procedure without any immediate complications noted.

The Breakdown

The surgeon documented moving the flexible laryngoscope into the endolaryngeal area (-into the oropharynx and supraglottis-). The above documentation has the scope looking further down the throat than the soft nasopharynx, which is where 92511 ends. Therefore, you should report 31575 for the surgeon's procedure. 
 
Your coders should sit down with their ENTs to discuss the differences between the two codes. If, during the conversation, the physician tells you that he did not perform a larynx examination, determine which procedure he performed and let him know which factors he must dictate to bill the other procedure, says Heather Corcoran, coding manager at CGH Billing in Louisville.

Check Carrier Guidelines

Most payers cite similar guidelines for coding nasopharyngoscopy and laryngoscopy. Cigna Medicare, for example, publishes a policy that states, -92511 should be used when studying the area extending from the posterior edge of the soft palate to the nasopharyngeal wall, including the eustachian tube openings.-
 
If your carrier publishes similar guidelines, you can show the policy to your physician to let him know exactly what the insurer is expecting him to document if he plans to report 92511.
 
Empire Medicare's policy states that 92511 only includes looking at the eustachian tubes, adenoids and choanae (where the pharynx and the nasal passages meet, at the end of the hard palate), which are all located in the nasopharynx. If the scope goes beyond the nasopharynx, your surgeon probably performed a laryngoscopy.

Let Medical Necessity Rule

Tip: Remember never to select a CPT code based on which codes your carrier will pay with your patient's diagnosis. Always let medical necessity drive your
coding choice.
 
For a breakdown of laryngoscopy codes and a primer on anatomic coding, see our article -Let This Chart Help You Pinpoint Accurate Endoscopy Codes- on page 59.