Otolaryngology Coding Alert

Question: Our surgeon performed a fiberoptic laryngoscopy to evaluate the patient's response to voice therapy and found a nasopharyngeal mass. The surgeon took the patient to the OR for a direct laryngoscopy, vocal cord stripping, and a nasopharyngeal biopsy. Can I code the nasopharyngeal biopsy in addition to the direct laryngoscopy, or is it included as part of the approach?

Answer: The nasopharyngeal biopsy is separately reportable, and you should code it with 42804 (Biopsy; nasopharynx, visible lesion, simple). A direct laryngoscopy (unlike a fiberoptic laryngoscopy) does not include any work in or examination of the nasopharynx.

Report the vocal cord stripping with 31540 (Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis) or 31541 (... with operating microscope or telescope). Use 31541 if your physician used the operating microscope. On the other hand, use 31540 if your physician did not use any microscope or telescope to perform the vocal cord stripping.

It appears the nasopharyngeal lesion was visible, thus 42804 may be the most appropriate because it is used to report a biopsy of the nasopharynx, for a visible simple lesion. Append modifier 51 (Multiple procedures) to the nasopharyngeal biopsy CPT code as this code has less RVU value than the vocal cord stripping CPT codes.