Otolaryngology Coding Alert

Just one more detail will separate it from your current choice.

When your otolaryngologist diagnoses paralysis of the vocal cords, you might not always have enough details to report whether it is partial or complete, unilateral or bilateral. In those circumstances, you currently submit ICD-9 code 478.30 (Unspecified paralysis of vocal cords). You may also apply the same code when the physician diagnoses laryngoplegia and paralysis of glottis.

ICD-10 switch: Effective Oct. 1, you will use the ICD-10 code J38.00 (Paralysis of vocal cords and larynx, unspecified) to report vocal cord paralysis. Except for the addition of the word “larynx” in the ICD-10 code, you should note no other significant changes. ICD-10 provides a bit of a break in documentation and coding for vocal cord paralysis as the concept of partial and complete paralysis is no longer broken into separate codes. ICD-10 only differentiates between unilateral or bilateral paralysis.

Documentation: ICD-10 limits your vocal cord paralysis choices to J38.0x (Paralysis of vocal cords or larynx). When reading a CT scan report, the physician should know whether the paralysis is partial or complete, as well as the area where the paralysis occurs (i.e., left side only). Only when you can’t get a confirmed diagnosis from the ordering physician should you report the unspecified code J38.00.

Coder tips: When trying to diagnose vocal cord paralysis, the ENT typically conducts a general examination and then questions you about your symptoms and lifestyle (voice use, alcohol/tobacco use). To examine the voice box, she would likely perform laryngeal electromyography (LEMG), which measures electrical currents in the voice box muscles that are the result of nerve inputs. The ENT would usually require other tests (i.e., blood tests, x-rays, and CT scans) to identify the cause of the paralysis.

Check Your Other Options

If your physician includes more details about the patient’s condition, you should be able to report a more specific diagnosis code under both ICD-9 and ICD-10. The following table outlines those choices. Note that the ICD-10 codes still specify unilateral or bilateral, but don’t differentiate between partial or complete paralysis.

Understand the condition: Voice cord paralysis results from abnormal nerve input to the voice box (laryngeal) muscles. Paralysis happens when a patient experiences total interruption of nerve impulse, resulting in no movement. This condition may result in voice changes (i.e., breathy voice, hoarseness), airway problems (i.e., shortness of breath with exertion, noisy breathing, and ineffective cough.), and swallowing difficulties (i.e., choking or coughing when swallowing food, drink, or even saliva, and food sticking in throat).