Otolaryngology Coding Alert

Treat telescope and operating microscope as equals

You-ll no longer have to question the correct code to report when your ENT uses a telescope during many laryngoscopic surgeries: CPT 2006 treats the telescope as an equal of the operating microscope and effectively includes telescope use with a half-dozen laryngoscopy codes.

Telescope Isn't Separate

New language in CPT means you should treat telescope use for visualization as an inclusive component of the following (new text underlined):

- 31526--Laryngoscopy, direct, with or without tracheoscopy; diagnostic, with operating microscope or telescope

- 31531--Laryngoscopy, direct, operative, with foreign body removal; with operating microscope or telescope

- 31536--Laryngoscopy, direct, operative, with biopsy; with operating microscope or telescope

- 31541--Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope or telescope

- 31561--Laryngoscopy, direct, operative, with arytenoidectomy; with operating microscope or telescope

- 31571--Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope or telescope.

Physicians and coding experts have anticipated the inclusion of -or telescope- language with these laryngoscopic procedures for some time, said Jill M. Young, CPC, an AAPC National Advisory Board member and president of Young Medical Consulting in East Lansing, Mich., in a recent instructional teleconference titled -2006 Otolaryngology Coding Update.- In fact, CPT has treated the operating microscope and telescope on an equal footing in the descriptors of similar procedures since the addition of 31546 (Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion[s] of vocal cord; reconstruction with graft[s] [includes obtaining autograft]) and other codes in CPT 2005.

Don't -Double Report-

You should only report a single unit of any of the above procedures, even if the ENT uses both a telescope and an operating microscope for visualization during the same session. CPT guidelines preceding endoscopy codes 31505-31579 clearly indicate, -If using operating microscope, telescope, or both, use the applicable code only once per operative session.-

-In other words, you won't get paid twice for using two different visualization methods,- says Charles F. Koopmann Jr., MD, MHSA, professor and associate chair at the University of Michigan's department of otolaryngology in Ann Arbor. -Coding--and reimbursement--stays the same whether the ENT uses the telescope, the operating microscope, or both.-

Another bundle to avoid: You should never report +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]) in addition to any procedure with a descriptor that indicates -with operating microscope.-

-If the code descriptor mentions -with operating microscope,- reporting 69990 in addition would constitute double-billing and could get you into trouble,- Young says.