Otolaryngology Coding Alert

Question: I’m looking for a direct laryngoscopy code that includes a tracheoscopy, going beyond the larynx, to remove granulation tissue from a tracheostomy site that is blocking 90 percent of the patient’s airway. I’m considering 31578, 31615, or the unlisted code 31899.

New York Subscriber

Answer: Taking a look at each of the two established codes, it’s clear neither will suffice in fully reporting the physician’s services. First, 31578 (Laryngoscopy, flexible; with removal of lesion(s), non-laser) does not include the tracheoscopy portion of the service. Additionally, you should not consider the removal of granulation tissue to be one in the same with the removal of a lesion.

Code 31615 (Tracheobronchoscopy through established tracheostomy incision) is also incorrect due to the fact that the physician’s approach is not through the established tracheostomy site. You can also see that it does not include the laryngoscopy portion of the exam and includes a bronchoscopy service that the physician does perform.

You might be inclined to report code 31525 (Laryngoscopy direct, with or without tracheoscopy; diagnostic, except newborn); however, this code does not include the removal of the granulation tissue. Ultimately, your options are either to:

• Submit the claim using the unlisted code 31899 (Unlisted procedure, trachea, bronchi) and include documentation outlining the full extent of the service; or 
• Submit the claim using code 31525 with modifier 22 (Increased Procedural Services) appended to describe the physician’s removal of the granulation tissue.

With the information available at hand, you should opt to code the provider’s services as 31899 and equate the code to 31528 (Laryngoscopy direct, with or without tracheoscopy; with dilation, initial) with a modifier 22 appended. Since 31528 includes a tracheoscopy and dilation, using this code will give you the best shot at receiving proper reimbursement for the provider’s services.