Otolaryngology Coding Alert

Question: A surgeon performed two procedures during the operative session: 

• Direct laryngoscopy with microsuspension laryngoscopy and excision of bilateral vocal cord lesions  
• Biopsy of left vallecular lesion. 

He used the operating microscope for the first procedure, but did not for the second. He excised the vallecular lesion using a cup forceps, then the microscope was brought into place for the excision of bilateral vocal cord lesions. Can I code 31536 and 31535-59? Also, would it be better to code 31541 for the excision of vocal cord lesions? 

Kentucky Subscriber

Answer: In this scenario you should only submit 31541 (Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope or telescope). The other biopsy code 31535 (Laryngoscopy, direct, operative, with biopsy) is bundled into the more extensive excision code.

There’s no need to append modifier 50 (Bilateral procedure) to 31541. The Medicare physician fee schedule specifies that bilateral reporting is not allowed for this procedure. You also won’t need modifier 59 (Distinct procedural service) since you’re only filing with one procedure code.