Otolaryngology Coding Alert

Question: The surgeon performed a direct laryngoscopy and removed polyps from the patient’s right and left vocal cords. Why don’t we use modifier 50 on CPT® codes 31540 or 31541 to indicate bilateral? This is the same case for 31541.

Washington Subscriber

Answer: To learn whether a CPT® code accepts a modifier indicating the side treated (50 for bilateral or RT or LT if you’re reporting the procedure for only one side,) look on the National Physician Fee Schedule. Under 31540 (Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis) you’ll see a “0” in the “BILAT SURG” column, indicating that you should not report a laterality or bilateral modifier with the code.

Anatomy note: The larynx is considered a central structure, so procedures to that area are not typically reported as bilateral procedures. The verbiage in 31540 and 31541 (Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope or telescope) both state “vocal cords.” As such, you only report these codes one time for an encounter because the procedure includes both cords.