Otolaryngology Coding Alert

Question: Can you please help me with the correct code for superior adenoidectomy via “nasal approach”? The surgeon assessed the nasaopharynx and used biopsy forceps to debulk and obtain specimens from the majority of the adenoid/nasopharyngeal tissue. He stayed completely within the nasal cavity. I can’t quite put decide on the best code for this. 

Maryland Subscriber 

Answer: CPT® doesn’t include a code that matches the approach you describe. Direct laryngoscopes are through the mouth. Code 31276 (Nasal/sinus endoscopy, surgical with frontal sinus exploration, with or without removal of tissue from frontal sinus) is for flexible laryngoscopy with a biopsy, but this seems to represent a more extensive service than your surgeon performed. Some coders might consider 31276-22 (Reduced services), but you are not going all the way to the larynx, you are only going to the nasopharynx. Therefore, your best option probably is an unlisted code such as 31599 (Unlisted procedure, larynx) because CPT® doesn’t have a code for unlisted procedures on the nasopharynx.