Otolaryngology Coding Alert

Question:

Vermont Subscriber

If a patient complains of a recurrent pain in the oropharynx and face, and upon examination the physician finds out the pain is due to an elongated styloid process or calcified stylohyoid ligament, the patient likely suffers from Eagle's syndrome. Treatment of this condition usually consists of surgically shortening the styloid process.

What is: The styloid process is a slender outgrowth at the base of the temporal bone, immediately posterior to the mastoid apex.

Since no specific ICD-9 code for the syndrome exists, you would be best coding for symptoms presented by the patient. Symptoms include: facial pain (784.0), throat pain (784.1), neck pain (723.1) and dysphasia (784.5). Other options may be trigeminal neuralgia (350.1) or other disorders of muscle, ligament and fascia (728.89).

Extra: Use 21499 (Unlisted musculoskeletal procedure, head) when coding for shortening of the styloid process. Submit the documentation with the claim with a cover letter, explaining what was done and equating the procedure to another listed procedure, assisting the payer to assign a value to the unlisted procedure.