Otolaryngology Coding Alert

Answer: Codes 31541 (laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope) and 31571 (laryngoscopy, direct, with injection into vocal cord[s], therapeutic; with operating microscope) cannot be billed using modifier -50 (bilateral procedure), as the descriptors for both indicate more than one vocal cord may be involved. The two codes are not bundled in Medicares national Correct Coding Initiative, nor is either code considered a separate procedure. So if the mass is excised and the injection is performed, both 31541 and 31571 should be billable, says Barbara Cobuzzi, MBA, CPC, CPC-H, an independent otolaryngology coding and reimbursement specialist in Lakewood, N.J. The injection, however, must be fully independent of the mass excision for both codes to be billed.

Use modifier -59 to indicate the injection was performed at a separate site, and appeal your denials on this basis. There is a good chance that commercial off-the-shelf software bundling packages, such as HBO&Cs GMIS ClaimCheck, bundles the two codes. Still, using modifier -59 to indicate separate sites and appealing denials with your documentation may result in both codes being paid. Keep in mind, however, that the multiple procedure fee reduction will apply even if the claim is accepted.

Although 31541 describes an excision of a single tumor (but multiple cords), if more than one tumor is removed, the second excision should be billed with an additional 31541-59, to indicate a separate site.