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.

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.