Otolaryngology Coding Alert

Question: Can I bill 31541 bilaterally to represent a bilateral laryngoscopy with operating microscope and stripping of vocal cords on both sides of the throat?

California Subscriber

Answer: No. You should not append modifier 50 (Bilateral procedure) to 31541 (Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottitis; with operating microscope or telescope).

The National Physician Fee Schedule Relative Value File assigns 31541 a bilateral surgery indicator of "0," meaning the 150 percent payment adjustment for bilateral procedures does not apply. "The bilateral adjustment is inappropriate for codes in this category (a) because of physiology or anatomy, or (b) because the code description specifically states that it is a unilateral procedure and there is an existing code for the bilateral procedure," according to the file.

Instead: You should report 31541 for stripping of vocal cords, plural. Bill 31541 once, regardless of the number of vocal cords stripped or of the stripping's location, as in both sides of the throat. The code's descriptor indicates stripping of vocal cords, not cord, meaning the code represents single and/or multiple stripping.

Exception: Because 31541's descriptor indicates "excision of tumor" in the singular, the code does not include multiple tumor removals. So if the otolaryngologist removed multiple tumors from the vocal cords, you could bill additional lesion removals with 31541-59. Modifier 59 (Distinct procedural service) indicates that the additional lesion removal occurred at a separate site from the initial tumor removal.