Otolaryngology Coding Alert

Question: What is the difference between a direct and indirect laryngoscope?

Connecticut Subscriber Answer: Indirect laryngoscopy involves the use of a laryngeal mirror placed in the back of the throat and another mirror held outside the mouth. With a light source, the otolaryngologist views the larynx indirectly by manipulating the mirrors. Direct laryngoscopy involves the use of a laryngoscope in the mouth to directly view the larynx and adjacent structures.

Indirect laryngoscopy is simpler than direct laryngoscopy. The five procedures in this category do not involve a scope and offer the least reimbursement. The simplest of these codes (diagnostic) (31505, laryngoscopy, indirect; diagnostic [separate procedure]) is often used during a routine examination and should not be billed separately.

Other services performed via indirect laryngoscopy are:

- 31510 -- ... with biopsy

- 31511 -- - with removal of foreign body

- 31512 -- - with removal of lesion

- 31513 -- - with vocal cord injection.  Direct laryngoscopy almost always takes place in the operating room under general anesthesia or conscious sedation. This laryngoscopy category is the largest (17 codes) and involves the most complex procedure. The most commonly performed direct laryngoscopies are:

- 31535 -- laryngoscopy, direct, operative, biopsy

- 31536 -- ... 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.