Otolaryngology Coding Alert

Question: Our ENT administered percutaneous laryngeal injections using flexible endoscopic guidance. How do I code for that?

Michigan Subscriber

Answer: The correct answer depends on what your physician injects into the larynx and why. For example, if he injects Botox to treat spasmodic dysphonia, you would report 64617 (Chemodenervation of muscle[s]; larynx, unilateral, percutaneous [e.g., for spasmodic dysphonia], includes guidance by needle electromyography, when performed). This code represents a percutaneous injection of Botox into the larynx. If the provider uses a laryngoscopy to guide, then you also would code the laryngoscopy (based on the type – flexible or direct). 

Physicians can administer injections to the larynx for other reasons, such as injecting Radiesse into the vocal folds. You wouldn’t report 64617 in that situation. Instead, you would submit unlisted laryngeal code 31599 (Unlisted procedure, larynx).  In this setting, code 31599 includes both the injection and the flexible laryngoscopy. 

Depending on which material your physician injected, you might be able to separately report the material with a J code. 

Take note: CPT^® codes 31570 (Laryngoscopy, direct, with injection into vocal cord[s], therapeutic) and 31571 (…with operating microscope or telescope) are used to report injections performed using rigid, direct laryngoscopy. They are not appropriate to use for injections performed using either flexible fiberoptic or flexible distal-chip endoscopic guidance.