Otolaryngology Coding Alert

Question: The otolaryngologist performed a direct laryngoscopy, direct bronchoscopy, and rigid transoral esophagoscopy during the same session. Can I code each of these separately?

Nevada Subscriber

Answer: Yes, you can report all three of these services together, provided your physician performed them as a diagnostic procedure and used separate instruments. Be sure the documentation is very clear about completing three separate procedures using three separate instruments (if your physician did not use separate instruments, you cannot report each one). You will often find that the bronchoscope is fed through the laryngoscope. In this case, you would only code for one of the two scopes, since one scope was not removed and then the deeper scope inserted.

If the service meets those criteria, code it as follows:

• 31525 (Laryngoscopy direct, with or without tracheoscopy; diagnostic, except newborn)
• 31622 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed [separate procedure]) with modifier 59 (Distinct procedural service) appended
• 43191 (Esophagoscopy, rigid, transoral; diagnostic, including collection of specimen(s) by brushing or washing when performed [separate procedure]) with modifier 59.

Take note: Do not report one or more of these diagnostic codes if a more definitive surgical code applies for the same operative session.

Example: A laryngectomy includes the work of a diagnostic laryngoscopy when the physician performs both procedures during the same encounter, so you only code for the laryngectomy. However, if the physician performs an initial direct laryngoscopy to determine the need for a more definitive procedure (such as a laryngectomy) at the same operative session, you can report both services and append modifier 59 to the endoscopy code.