Pulmonology Coding Alert

Question: I have a report that documents a bilateral lesion destruction via laryngoscopy. I’m only finding a code for a laryngoscopy with unilateral destruction of lesions.

Do I need to append a bilateral modifier to the procedure code?

Pennsylvania Subscriber

Answer: Yes, you are correct! In the 2023 CPT^® code set, as in 2022, you’ll find 31572 (Laryngoscopy, flexible; with ablation or destruction of lesion(s) with laser, unilateral) features the word “unilateral” in the code descriptor. Since there isn’t a separate code to represent bilateral lesion destruction via laryngoscopy, you’ll append modifier 50 (Bilateral procedure) to 31572.

During the procedure, the provider guides a flexible laryngoscope into the patient’s larynx (voice box) to evaluate any abnormalities and uses a laser to destroy lesions found on the larynx. Code 31572 is specifically for the destruction of the lesions. If the provider were to take a biopsy or multiple biopsies of the lesions, you’d assign 31576 (… with biopsy(ies)), whereas you’d assign 31578 (… with removal of lesion(s), non-laser) if the provider removed lesions from the larynx without the use of a laser. It should be noted that 31576 and 31578 aren’t considered unilateral, so the bilateral procedure rules don’t apply. You can easily identify if bilateral procedure rules apply to your selected CPT^® code by reviewing the indicator under the Bilt Surg column on the Centers for Medicare & Medicaid Services (CMS) code look-up tool (www.cms.gov/medicare/physician-fee-schedule/search/overview).