Wiki Coding assist please

[hsmith67]

Please advise how you would code this to resolve two conflicting opinions:

After supine and general anesthesia through laryngectomy stoma... Next, using the anterior commissure laryngoscope the oral cavity, oropharynx into the neopharynx is well visualized. No evidence of recurrent disease. Next, along the posterior aspect of the cricopharyngeus muscle, 25 units of Botox was injected through a Tuohy needle. The rest of the Botox was destroyed. After the injection, dilation started with a #20F to a #44F, soft bougie dilators waas used to dilate the hypopharynx into the cervical esophagus. After dilation the area was visualized, no tear or mucosal abnormality seen. The concluded the case.

Thanks for any assistance.
Hunter Smith, CPC

 

[nickelclaw]

Found a coding clinic 3rd quarter 2011 pg 1

Botox injection into cricopharyngeal muscle using operating microscope
Coding Clinic for HCPCS - Third Quarter 2011 Page: 1

ASK the EDITOR
QUESTION 1

A patient with dysphagia, cricopharyngeal dysfunction and spasm with Schatzki's ring, presents for Botox injection into the cricopharyngeus. After general anesthesia is provided, a direct laryngoscopy and direct hypopharyngoscopy was performed. A microscope was used for direct visualization. Botox was injected into three areas of the posterior cricopharyngeus. The coders at our facility have been debating between codes 31571 and 64613. What is the appropriate code assignment for direct laryngoscopy with injection of Botox into the cricopharyngeal muscle using an operating microscope?

ANSWER

It would be inappropriate to report CPT code 31571, Laryngoscopy, direct, with injection into vocal cord(s), therapeutic, with operating microscope or telescope, because based on the operative report submitted, the injection was made in the neck muscles and not the vocal cords. Therefore, report CPT code 64613, Chemodenervation of muscles(s); neck muscle(s) (eg, for spasmodic torticollis, spasmodic dysphonia), and CPT code 31528, Laryngoscopy direct, with or without tracheoscopy; with dilation, initial, for the procedures performed.

This is the latest clinic on this but 64613 has been deleted so use 64616 with the 31528.
If bilateral 64616-50.

 

[hsmith67]

Nickelclaw,
Thanks so much!
Hunter Smith, CPC