Otolaryngology Coding Alert

Question: Our physician performed a flexible laryngoscopy with laser removal and biopsy of lesions on the right anterior and left mid-surface of the larynx. What CPT^® code(s) should I use?

Kansas Subscriber

Answer: For a flexible laryngoscopy with laser removal, you will want to consider one of the new 2017 laryngoscopy codes. Specifically, you will want to apply code 31572 (Laryngoscopy, flexible; with ablation or destruction of lesion[s] with laser, unilateral). Some coders might also consider including code 31576 (Laryngoscopy, flexible; with biopsy[ies]) since the surgeon performed a biopsy on both lesions. However, a National Correct Coding Initiative (NCCI) check reveals that these two codes are mutually exclusive to one another. NCCI instructs you to bundle code 31576 into 31572; therefore, you should only submit this claim with code 31572.

Choose Modifier Carefully

Since the surgeon is ablating lesions on both the left and right side of the larynx, your first instinct should be to check if a bilateral code exists. In this case, only the unilateral code is applicable, so you will want to submit the claim as 31572 with modifier LT (Left side) and 31572 with modifier RT (Right side).

If the 31572’s code descriptor did not specify laterality, then you would want to apply modifier 50 (Bilateral procedure) instead of modifiers LT and RT. When it comes to surgical coding, you want to follow by these Medicare guidelines when deciding whether or not a modifier 50 is applicable:

“Modifier 50 applies to a bilateral procedure performed on both sides of the body during the same operative session. When a procedure is identified by the terminology as bilateral or unilateral, the 50 modifier is not reported.”

In other words, if a CPT^® code descriptor labels it as inherently bilateral or unilateral, do not use modifier 50. Instead, you will opt for an LT/RT modifier for the unilateral procedures, and no modifier for the bilateral procedures.

Consider Use of Microscope

If the provider doesn’t use a microscope, you will take a look at code 31535 (Laryngoscopy, direct, operative, with biopsy) for the biopsy and 31540 (Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis) for the laser removal. However, like with the flexible laryngoscopy, 31535 is bundled into 31540. Therefore, you would only code 31540. Remember that you cannot use modifier 50 with either of these codes.

Similarly, if the provider uses a microscope, you will examine code 31536 (Laryngoscopy, direct, operative, with biopsy; with operating microscope or telescope) for the flexible laryngoscopy with biopsy and 31541 (Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope or telescope) for the flexible laryngoscopy with laser removal. 31541 is also ambiguous as to what is used to remove the tumor and not specific to a laser, but can include a laser.

Like with the flexible laryngoscopy and the direct laryngoscopy codes without microscopy, 31536 for the biopsy is bundled into the 31541 for the removal of the tumor. Therefore, only 31541 is coded. Do not apply modifier 50 to either of these codes.

Tip: If you’re ever unsure of whether you can bill a surgical code with modifier 50, you can check the specific code’s bilateral indicator status. You can look up a code’s indicator in CMS’s Relative Value File, which is updated every quarter. In the CMS Relative Value File, a corresponding code’s bilateral status indicator can be found in the “Bilateral Surg” column.