Otolaryngology Coding Alert

Question: My physician did a punch excisional biopsy of the left tonsil, but I'm not seeing a code for this. What should I do?

Kentucky Subscriber

Answer: You don't see a code, because no specific code exists for a biopsy of the tonsils.

You should instead report the code based on whether the otolaryngologist used a scope. If he didn't, you should assign 42800 (Biopsy; oropharynx).

If the physician used an endoscope, you should report 31535 (Laryngoscopy, direct, operative, with biopsy) or 31536 (... with operating microscope).

Note: CPT classifies "indirect" laryngoscopy as an endoscopy, even though the procedure requires a mirror, not an endoscope.

 Answers to You Be the Coder and Reader Questions provided/reviewed by Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.