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Pulmonology Coding Alert

Look for This $125+ Boosting Phrase in Diagnostic Scope Notes

Published on Tue Apr 10, 2007

Error averted: Drop 31575 when biopsy occurs

Reporting 31575 when your pulmonologist actually performed 31525 can cut more than $125 from a claim. But zeroing in on key terms will help you avoid that costly error.

Tip 1: Zoom in on Rigid Vs. Flexible

If you have trouble pinpointing the appropriate laryngoscopy code, you're not alone. "How do I choose between 31525 (Laryngoscopy, direct, with or without tracheoscopy; diagnostic, except newborn) and 31575 (Laryngoscopy, flexible fiberoptic; diagnostic)?" asks Jeanne Smith, in the patient accounts department of Madrona Medical Group in Bellingham, Wash.

Key: "Code 31525 is for rigid laryngoscope, and 31575 is for flexible laryngoscope," says Denae M. Merrill, CPC, at Covenant CBO in Saginaw, Mich.

Clinical lowdown: Physicians may use a rigid scope, which is a straight metal instrument that goes into the throat, for surgical procedures, such as removing foreign objects, collecting tissue (biopsy), removing polyps, or performing laser surgery, Merrill says. A rigid scope also aids in diagnosing cancer of the voice box (larynx).

In contrast, a flexible scope allows better diagnostic views and is tolerated better by patients. "It is a pencil-thin, flexible fiber optic scope that goes in through the nose and then down the throat," Merrill says.

Because of the higher risk associated with performing a rigid scope, 31525 carries more than twice the physician work relative value units as 31575 -- 2.63 work RVUs for 31525 compared to 1.10 for 31575. Overall, using the 2007 National Physician Fee Schedule, 31525, which has 6.38 transitional nonfacility total RVUs unadjusted, pays $127.72 more than 31575 with 3.01 NF total RVUs.

Tip 2: Convert to Surgical Code if 31575 Reveals a Problem

Make sure you replace 31575 with a surgical flexible scope code when your pulmonologist finds a problem during a diagnostic scope. Based on CPT guidelines and multiple-endoscopy payment rules, you report the surgical scope only, not both the diagnostic and the surgical scope.

You code it: A pulmonologist documents a "direct laryngoscopy used to view the vocal cords by using a fiberoptic scope without taking a biopsy." You should code the procedure with 31575, says Miller, who is also president-elect of the Midland Bay Saginaw Chapter of the American Academy of Professional Coders. Link the diagnostic code to the presenting complaint or problem, such as halitosis (784.99, Choking, sneezing, halitosis, mouth breathing).

CEU opportunity: But if the procedure revealed a polyp on the vocal cords (478.4 Polyp of vocal cord or larynx) that the pulmonologist took a sample of, you should instead assign 31576 (...wiith biopsy). Other options include:

--31577 -- ... with removal of foreign body possibly linked to ICD-9 code 933.1, Foreign body in larynx

--31578 -- ... with removal of lesion linked to ICD-9 code 478.29, Pharyngeal polyp.

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