Otolaryngology Coding Alert

Question: Our surgeon plans to complete an intraoral excision of bilateral stylomandibular ligaments with complex closure. The patient’s diagnoses are Eagle syndrome and chronic neck pain. Can you offer any suggestions on coding?

West Virginia Subscriber

Answer: There is no specific diagnosis code for Eagle’s syndrome, which means you’ll code based on the patient’s presenting symptoms. These could include facial pain (784.0), throat pain (784.1), neck pain (723.1) and dysphasia (784.5). Other options may be trigeminal neuralgia (350.1) or other disorders of muscle, ligament, and fascia (728.89).

Patients with Eagle’s syndrome have recurrent pain in the oropharynx and face due to an elongated styloid process or calcified stylohyoid ligament. Treatment consists of surgically shortening the styloid process, which is a slender outgrowth at the base of the temporal bone, immediately posterior to the mastoid apex. CPT® does not include a code for this procedure, so your best option is to submit 21499 (Unlisted musculoskeletal procedure, head) with documentation and a cover letter explaining your surgeon’s work.