Actually, before anesthesia is administered, a flexible laryngoscopy is performed, not a flexible nasal endoscopy. The flexible scope goes down to the vocal cords, which is in the larynx. 31575 is bundled with with 31622 and there is no modifier allowed to unbundle the two codes, so 31575 cannot be coded.
31622 and 31525 are also bundled but their bundle does allow an over ride using a modifier if applicable. However, it is not clear if a diagnostic bronchoscope (31622) or a Tracheobroncoscopy (31615) through the Trach incision was performed. The trach tube was removed. Was the bronchoscope put through the mouth or the trach incision? The op note does not make it clear. And the removal of the laryngoscope is not detailed in the note. For the bronchoscopy and the direct laryngoscopy to qualify for a 59 or XS modifier, the note has to show the laryngoscope pulled out and the bronchoscope put in the mouth (if the bronchoscope entered the mouth. But if the bronchoscope went in the trach incision, then the 59 or XS is supported, but it is not clear where the bronchoscope is entered.
