Part B Insider (Multispecialty) Coding Alert

Question: I'm trying to understand how to distinguish between nasopharyngoscopy and laryngoscopy. What role does the scope play?


Michigan Subscriber

Answer: When choosing between nasopharyngoscopy (92511, Nasopharyngoscopy with endoscope [separate procedure]) and laryngoscopy (31575, Laryngoscopy, flexible fiberoptic; diagnostic), you should not consider whether the ENT introduces the scope through the mouth or the nose, as you might think. Instead, the key to proper coding is the anatomic area (nasopharynx or larynx) the ENT examines with the scope.

Red flag: Sometimes physicians choose to perform a nasal scope insertion for a laryngoscopy because this approach is easier than making the patient hold his mouth open for a long time, and because going through the nose doesn't provoke the patient's gag reflex, says Tom Colletti, MPAS, PA-C, with Duke Medical Center in Durham, NC. So if you read "nasal scope insertion" in your physician's documentation and assume he performed a nasopharyngoscopy, you could be jumping to the wrong conclusion.

Remember: Code 92511 reimburses higher than 31575 in the nonfacility setting (3.32 relative value units versus 1.91 RVUs, or about a $50 difference, on average), so choosing the correct code has significant meaning for your bottom line, says Mary Tait, CPC, with Amerimed Billing and Consulting in Pocatello, ID.

Tip: Read your ENT's documentation very thoroughly to discern what anatomic part he examined with the scope procedure; this fact should guide your code selection. For example, if the documentation states the physician performed a nasal scope insertion and examined the interior of the patient's larynx (this provides a better view of the upper airway than a traditional mirror exam), you would report code 31575.

If, however, the physician examines the nasopharynx (that is, the eustachian tubes, adenoids and choanae, or the area where the pharynx and the nasal passages meet at the end of the hard palate), the correct code is 92511, regardless of where the ENT introduces the scope.