Otolaryngology Coding Alert

Question: The ENT examines a child for airway obstruction. He inserts the scope through the nose and examines down to the base of tongue/tonsils. Although this seems like a laryngoscopy, the physician was primarily concerned with airway obstruction. Should I report this as a nasopharyngoscopy (92511) or a laryngoscopy (31575)?


New Jersey Subscriber

Answer: Although you might be able to make a case for reporting nasopharyngoscopy, laryngoscopy is probably more appropriate in this situation.

Empire Medicare local coverage determination (LCD) guidelines state that you should report 92511 (Nasopharyngoscopy with endoscope [separate procedure]) when -studying the area extending from the posterior edge of the soft palate to the nasopharyngeal wall, including the Eustachian tube openings.-

As such, 92511 is appropriate when the physician looks at the Eustachian tubes, adenoids and tubes, and/or the adenoids and choanae, all of which are located in the nasopharynx.

If the physician pushes the scope further, down to the larynx, you should instead choose 31575 (Laryngoscopy, flexible fiberoptic; diagnostic). Although this is the more -extensive- procedure, 31575 actually pays less than 92511 under the current physician fee schedule database.

Alternative scenario: What if the physician examines the nasal septum, adenoids and tonsils, base of tongue, and larynx? Should you choose a nasopharyngoscopy for examination of the nasopharynx; nasal endoscopy, 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) for the nasal cavity; or laryngoscopy for examination of the hypopharynx?

Once again, you should choose only the most -extensive- procedure, 31575, although this is not the highest-paying procedure.