Otolaryngology Coding Alert

Question: The otolaryngologist performed two procedures during an operative session: 1) Direct laryngoscopy with microsuspension laryngoscopy and excision of bilateral vocal cord lesions; and 2) Biopsy of left vallecular lesion. He used the operating microscope for the first procedure, but 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 with a modifier (such as 59)? Also, would it be better to code 31541 for the excision of vocal cord lesions?

Michigan Subscriber

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

You may not append modifier 50 (Bilateral procedure) to 31541. The Medicare fee schedule specifies that you cannot report bilateral service for this procedure. 

Coding edits bundle 31541 and 31536, although the procedures could be unbundled with a modifier if it applied (i.e., separate encounters on the same day). Unfortunately, there are no circumstances to justify a modifier to unbundle these two codes, so 31536 cannot be also billed. Report 31541, which has higher RVUs.