Otolaryngology Coding Alert

Question: What CPT code should I use for the following procedure: Patient has (R) thin, vocal fold resulting in incomplete closure of vocal cords. Otolaryngologist plans -thyroplasty with Gore-Tex ribbon,- which he will use to -bulk up- the right side to allow closure of the vocal cords. Patient will be under moderate sedation to allow patient to speak during procedure.


Maine Subscriber

Answer: The surgery your otolaryngologist plans to perform is also called medialization laryngoplasty, which is technically an Isshiki type I thyroplasty with ePTFE (Gore-Tex). During the procedure, the otolaryngologist manipulates the patient's vocal cord position through a neck incision. Through this incision, he removes a small window of cartilage next to the vocal cord. Through this window, he places an implant (Gore-Tex) to secure the vocal cord in a more medial position.

The CPT system contains no listing for thyroplasty, so you should use an unlisted-procedure code for the larynx, 31599 (Unlisted procedure, larynx), per AAO-HNS recommendations. Although the prefix -thyro- stands for thyroid, thyroplasty occurs in the larynx. To access the vocal cords, the surgeon must cut a small window in the thyroid cartilage.

In accordance with unlisted-procedure code reporting requirements, include a -brief description of the service with the claim (in the -description- area if you-re billing electronically, or in a separate note if you-re billing on paper),- the Academy says in its FAQ on thyroplasty.

If your otolaryngologist used the Gore Thyroplasty Device and performed the procedure in a facility, the facility will report the implant with HCPCS supply code C1878 (Material for vocal cord medialization, synthetic [implantable]). Doctors should never bill C codes.

Further, Medicare now allows the otolaryngologist who performed the procedure to also code sedation that he provides. Therefore, you may also report 99143-99145 (Moderate sedation services ... provided by the same physician performing the diagnostic or therapeutic service that the sedation supports ...).

Beginning Oct. 1, -Physicians who both perform, and provide moderate sedation for, medical/surgical services will be paid for the conscious sedation consistent with CPT guidelines,- according to MLN Matters Number: MM5618 available at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5618.pdf. Medicare previously only paid for moderate sedation when one physician performed the procedure and another physician sedated the patient (99148-99150, Moderate sedation services - provided by a physician other than the healthcare professional performing the diagnostic or therapeutic service that the sedation supports -). CMS, however, has not yet assigned relative value units for these services.