Wiki Please help with laser removal of glottic stenosis!

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AN2114

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Auburn Hills, MI
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I have codes 31622, 31528, and 31570 but from my research the laser removal of stenosis is an unlisted code. I would like to avoid using the unlisted code so does anyone know if there is a better cpt code? or if that would be included in one of the other procedures? I was looking at 31572 but it is laser removal of lesions so I wasn't sure if I could use that. Here is the op report:

Procedure: Direct Laryngoscopy, bronchoscopy, with balloon dilation of posterior glottic stenosis and laser removal of posterior glottic stenosis, steroid injection into posterior glottic stenosis

Procedure details:

Using a Philips laryngoscope the supraglottic structures we evaluated, no gross abnormalities were identified, no signs of laryngomalacia or GERD were observed. There was signs of minimal posterior glottic stenosis. Using a rigid bronchoscope the glottic introitus was entered. The immediate subglottis was of normal caliber. The proximal and distal trachea were bronchomalacia or foreign bodies were observed. The prior site for laryngotracheal reconstruction was healed appropriately.

Patient's supraglottis was identified and isolated using a Lindholm laryngoscope. Upon doing so, the laryngoscope was suspended and secured on the Mayo stand. Once suspended using the hopkins rod and omniguide late, the posterior glottic stenosis was lasered on a setting of 3 watts. The posterior glottic stenosis shrunk down appropriately. Next the balloon was used to dilate the glottic area to a setting of 17. This was done twice and the glottic aperture was appropriately widened. Kenalog 40 mg was injected into the posterior glottic area to soften up the scar tissue. At this point the procedure was complete. Patient was then turned over to anesthesia which woke the patient and transferred him to PACU in stable condition.
 
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Unfortunately there is no such code, the flex scope is the only one with the laser excision. Using the unlisted code is truly your only option and if you do it correctly by sending a statement using 31541 as the comparative CPT code with your op note you should be fine.
 
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Even though there is no laser destruction code for direct laryngoscopy codes, there is:

31540:Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis
31541:Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope or telescope

These cpt codes describe what is being performed with laser destruction of a lesion via direct laryngoscopy and have are what we use, depending if the operating microscope or telescope is used.

31630 ( Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with tracheal/bronchial dilation or closed reduction of fracture) is what would be used for the balloon dilation of the glottis stenosis. 31622 is bundled and not coded. 31570 is correct.

31540/41 is bundled into 31570 but a modifier can be used to override. But I feel that the op note does not support overriding. There is nothing that shows it is a distinct procedural service.
 
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Actually, tiaralady6466, the destruction (31540/41) is bundled into the kenalog injection (31570/71) which has higher RVUs and I cannot see any justification to use a modifier for distinct procedural service since they both were in the same area, so only the kenalog injection should be coded and billed.
 
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