Otolaryngology Coding Alert

Question:  Can a provider bill 31588 with 31575?

Iowa Subscriber

Answer:  Yes, you can bill 31588 (Laryngoplasty, not otherwise specified [eg, for burns, reconstruction after partial laryngectomy]) with 31575 (Laryngoscopy, flexible fiberoptic; diagnostic) if the two services qualify for a 59 modifier (Distinct procedural service). CCI edits consider 31575 to be a Column 2 code to 31588, so you would need documentation that supports you to append a modifier 59 before submitting both codes on a claim. In many cases this would mean appending modifier 59 or the appropriate X{EPSU} modifier to unbundle the edit pair. The general rules when performing advanced procedures on the larynx such as a laryngectomy or a laryngoplasty allows the diagnostic endoscopy to be billed for procedures on structures other than the larynx (e.g., esophagoscopy, bronchoscopy). Verify that you have sufficient documentation showing the services were separate from each other and were both medically necessary. 

Basically, in order to bill the flexible laryngoscopy, it probably would have to have been done during a separate encounter (XS) or perhaps a separate provider who may be performing a different reconstruction during the session (XP).