Otolaryngology Coding Alert

You’ll have a single code, but don’t misreport with a less specific option. 

 When ICD-10 goes into effect on Oct. 1, you will shift from 478.75 (Laryngeal spasm) to J38.5 when coding for laryngeal spasm. The two codes share the same descriptor, which means you will not have to adopt any significant changes when documenting, coding and billing the ICD-10 code.

What it is: Your otolaryngologist might diagnose a laryngeal spasm when a patient presents with narrowed or closed vocal cords that make it difficult to speak or breathe. You may also apply this code when the ENT diagnosed a patient with laryngismus (stridulus) or spasmodic dysphonia.

Coder tips: The physician might administer a direct vocal cord injection into the patient’s neck to treat laryngeal spasm. If so, an appropriate code might be 64617 (Chemodenervation of muscle[s]; larynx, unilateral, percutaneous [e.g., for spasmodic dysphonia], includes guidance by needle electromyography, when performed). If you’re reporting bilateral injections, be sure to append modifier 50 (Bilateral procedure) and include documentation of both injections.

Watch other options: Notice that the descriptor for 64617 gives an example of a condition the injection might be used to treat – spasmodic dysphonia. If your provider is treating Torticollis or cervical dystonia, the injection is in the neck, but not in the larynx. In this case, you should link either M43.6 (Torticollis) for cervical dystonia or G24.3 (Spasmodic torticollis) because those codes best describe the patient’s condition and the appropriate CPT® code would not be 64617, but it would go down one to 64616 (Chemodenervation of muscle(s); neck muscle[s], excluding muscles of the larynx, unilateral [e.g., for cervical dystonia, spasmodic torticollis]).

Don’t forget the drug: These injections are usually Botox into the larynx or neck. When billing in the office, do not forget to bill for the Botox in addition to the injection code with J0585 (Injection, onabotulinumtoxina, 1 unit). Make sure you bill for all the units used and do not default to only one unit as most injections are not for just one unit.

Another documentation tip: Payers have guidelines regarding how many chemodenervation injections a patient can receive within a certain time period (such as within a year) or how closely the injections can be administered. If the injection your otolaryngologist administers doesn’t meet the payer’s requirements, you’ll want to ask the patient to sign an advance beneficiary notice (ABN) for Medicare or other paperwork for private payers accepting payment responsibility. In the ABN, outline the service the physician will provide (laryngoscopy with Botox injection) and the reason the insurer might reject payment (excessive frequency). For a Medicare patient, append modifier GA (Waiver of liability statement issued as required by payer policy, individual case) to 64616 to indicate the patient signed an ABN.