Pulmonology Coding Alert

Question: Our pulmonologist recently performed a laryngoscopy procedure on one of our patients. The documentation states that a biopsy of the vocal cord was conducted during the procedure, but I am not too sure about how to report this procedure, as there are different laryngoscopy codes (for rigid and flexible scopes) to choose from.

Minnesota Subscriber

Answer: There are several methods used for laryngoscopy services:

Indirect laryngoscopy examines the voice box by placing a mirror in the back of the mouth at an angle for light to be directed to the voice box area. This provides a reflected image of the larynx. Indirect laryngoscopy is not preformed as frequently since flexible laryngoscopes allow for a better and more comfortable viewing.

Direct laryngoscopy examines the larynx by a scope to provide a magnified view of the voice box. Direct rigid laryngoscopy is often used in surgery under general anesthesia to remove foreign objects in the throat, collect biopsies, remove polyps from the vocal cords, or perform laser treatment. Flexible fiberoptic laryngoscopy examines the larynx through a flexible tube containing a fiberoptic light and magnified viewer to reach places not normally seen by other methods.

The correct code for this service is selected from 31510 (Laryngoscopy, indirect; with biopsy), 31576 (Laryngoscopy, flexible fiberoptic; with biopsy) or 31535 (Laryngoscopy, direct, operative, with biopsy). Check the documentation of the procedure to identify clues which reference the type of procedure (indirect or direct), the type of scope used (rigid or flexible), and the location (office or procedural unit). If the documentation does not provide adequate details, check with your pulmonologist for further confirmation and request an addendum to the documentation.