Otolaryngology Coding Alert

Question: Encounter notes indicate that the otolaryngologist performed a direct laryngoscopy to inject onabotulinumtoxinA (Botox) into the patient’s larynx. There is no mention of microscope or other visualization tool. The patient was sedated during the procedure. Notes indicate that the physician used 3 units of Botox. How should I code for this encounter?

Missouri Subscriber

Answer: For this claim, you’ll report 31570 (Laryngoscopy, direct, with injection into vocal cord[s], therapeutic). Also, remember to report J0585 (Injection, onabotulinumtoxinA, 1 unit) x 3 for the Botox supply if this procedure was performed in the office.

Don’t stop your coding there, however.

Modifier JW alert: If the otolaryngologist had to discard the rest of the Botox supply after the patient’s injection, you should report that supply with modifier JW (Drug amount discarded/ not administered to any patient) appended. Botox typically comes in 100- and 200-unit packages, so your coding would be based on the exact Botox wastage.

Let’s say the otolaryngologist opened a 100-unit Botox package for the encounter and then discarded the rest. On the line below J0585 x 3, you would report J0585 x 97 with modifier JW appended to show how much Botox the otolaryngologist discards.

If the Botox was injected in an ambulatory surgical center (ASC) or hospital operating room, the facility will bill for the Botox and waste. The physician will only bill for the laryngoscopy with injection.