Otolaryngology Coding Alert

Question: Our physician just purchased a flexible laryngoscopy that uses a distal-chip scope. How should we code the procedure when he uses this? 

Maryland Subscriber 

Answer: You’ll report the same codes as usual: 

• 31575 – Laryngoscopy, flexible fiberoptic; diagnostic  
  
• 31576 – … with biopsy 
  
• 31577 – … with removal of foreign body 
  
• 31578 – … with removal of lesion. 
  

Explanation: Remember you’re coding for the physician’s work, not the tools he uses (except in special circumstances when a code such as +69990, Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) might apply. The optics and video sensor of a distal-chip flexible laryngoscope and different from those in a standard fiberoptic laryngoscope with attached video camera, but the technique and physician work are the same. That’s why you rely on the same codes, no matter which type of scope he uses. 

It is also possible that your physician will also perform 92511 (Nasopharyngoscopy with endoscope [separate procedure]) with this new scope. Remember to code what the doctor needed to do based on the medical necessity dictated by the patient complaints.  If the patient has an ear problem and the physician is checking the eustachian tube openings, he is only examining into the hypopharynx not the larynx.  He is therefore performing a 92511, not a 31575. Your payers will deny a 31575 billed with an ear diagnosis because you cannot support medical necessity.