Learn the Latest in Otorhinoloryngology

CPT 2017 captures the most up to date clinical services for ear, nose, and throat specialists.

CPT® 2017 brings several code changes for otorhinolaryngology, a specialty that has seen few, if any, code changes in the past several years. The changes are primarily new codes, with some code revisions, to keep the codes up to date with contemporary clinical practice.

Flexible Laryngoscopy Code Revisions

The laryngoscopy codes revised for 2017, and what’s different from 2016, are shown in Table A. These procedures involve the use of a flexible laryngoscope and are typically performed in the office setting, but may occur in the operating room.

New guidelines state not to report 31575 with 31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure), unless both are performed for separate conditions using separate endoscopes. Reporting both codes is not common, as both procedures are performed transnasal. The clinical rationale to support both codes should be documented clearly if both are reported. Both procedures should be separately documented, as well.

New Flexible Laryngoscopy Codes

New flexible laryngoscopy codes allow us to report procedures more commonly performed by otolaryngologists in the past several years. These procedures are also typically performed in the office setting, using a flexible laryngoscope, but may occur in the operating room. Here are the 2017 codes, with examples for practical application:

31572 Laryngoscopy, flexible; with ablation or destruction of lesion(s) with laser, unilateral

Code 31572 includes the removal of any number of lesions using the laser.

Example: Flexible laryngoscopy with laser ablation of recurrent laryngeal papillomatosis

31573 Laryngoscopy, flexible; with therapeutic injection(s) (eg, chemodenervation agent or corticosteroid, injected percutaneous, transoral, or via endoscope channel), unilateral

Code 31573 includes one or more injections at the same session.

Example: Flexible laryngoscopy with injection of steroids into the right vocal cord

31574 Laryngoscopy, flexible; with injection(s) for augmentation (eg, percutaneous, transoral), unilateral

Code 31574 includes one or more injections at the same session. The procedure is commonly known as a percutaneous injection laryngoplasty.

Example: Flexible laryngoscopy with vocal cord augmentation using a filler substance

All of these laryngoscopy codes are unilateral, which means modifier 50 Bilateral procedure may be appended if performed on both paired structures of the larynx/pharynx. CPT® guidelines state paired structures include true vocal cords, arytenoids, false vocal cords, ventricles, pyriform sinuses, and aryepiglottic folds.

Open Laryngoplasty: New, Revised, Deleted Codes

There are six new, three revised, and two deleted codes in the Larynx Repair section of CPT® 2017.

Direct laryngoscopy and bronchoscopy are included in all the open larynx repair codes for airway evaluation prior to the definitive procedure at the same operative session.

The following four codes reflect procedures for resection of laryngeal stenosis. These codes are differentiated by the age of the patient, and whether an indwelling stent was placed.

CPT® codes for patients younger than 12 years of age:

31551 Laryngoplasty; for laryngeal stenosis, with graft, without indwelling stent placement, younger than 12 years of age

31553
for laryngeal stenosis, with graft, with indwelling stent placement, younger than 12 years of age

CPT® code for patients aged 12 years or older:

31552 Laryngoplasty; for laryngeal stenosis, with graft, without indwelling stent placement, age 12 years or older

31554
for laryngeal stenosis, with graft, with indwelling stent placement, age 12 years or older

The graft harvest and placement is included in the above codes and should not be separately reported, even when performed through a separate incision.

The remaining two new airway CPT® codes are for specific procedures:

31591 Laryngoplasty, medialization, unilateral

Code 31591 is typically performed for vocal fold paralysis.

31592 Cricotracheal resection

Code 31592 is usually performed for subglottic stenosis.

There are three revised airway procedure codes in 2017. These are listed in Table B, with an explanation of the difference in code description from 2016.

Two airway procedure codes, 31582 and 31588, were removed to correspond with the new and revised codes, noted above.

Moderate Sedation

Deletion of the “moderate sedation included” symbol () affected many otolaryngology endoscopy codes, such as 31615 Tracheobronchoscopy through established tracheostomy incision, the bronchoscopy codes (e.g., 31622 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure)), and many esophagoscopy codes (e.g., 43200 Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)).

Kim Pollock

Kim Pollock

Senior Consultant at Karen Zupko & Associates
Kim Pollock, RN, MBA, CPC, CMDP, is a senior consultant and speaker with Karen Zupko & Associates, Inc., a physician practice management consulting and training firm based in Chicago, Ill. She is on the faculty for the American Association of Neurological Surgeons coding and reimbursement courses. Pollock has recently co-authored the book The Essential Guide to Coding in Otolaryngology.
Kim Pollock

About Has 3 Posts

Kim Pollock, RN, MBA, CPC, CMDP, is a senior consultant and speaker with Karen Zupko & Associates, Inc., a physician practice management consulting and training firm based in Chicago, Ill. She is on the faculty for the American Association of Neurological Surgeons coding and reimbursement courses. Pollock has recently co-authored the book The Essential Guide to Coding in Otolaryngology.

One Response to “Learn the Latest in Otorhinoloryngology”

  1. Diaren says:

    The new code 31572 & 3174
    # 31572
    with ablation or destruction of lesion(s) with laser, unilateral

    (Do not report 31572 in conjunction with 31576, 31578)
    (To report flexible endoscopic evaluation of swallowing, see 92612-92613)
    (To report flexible endoscopic evaluation with sensory testing, see 92614-92615)
    (To report flexible endoscopic evaluation of swallowing with sensory testing, see 92616-92617)
    (For flexible laryngoscopy as part of flexible endoscopic evaluation of swallowing and/or laryngeal sensory testing by cine or video recording, see 92612-92617)
    # 31573
    with therapeutic injection(s) (eg, chemodenervation agent or corticosteroid, injected percutaneous, transoral, or via endoscope channel), unilateral
    # 31574
    with therapeutic injection(s) (eg, chemodenervation agent or corticosteroid, injected percutaneous, transoral, or via endoscope channel), unilateral

    Code 31574 is a column 2 code for 31572, These codes cannot be billed together in any circumstances.
    Code 31574 is bundled into code 31572 Code 31574 cannot be billed with 31572.
    CCI edit Rule:
    Standards of medical / surgical practice

    Questions?
    1- Why we cannot bill this 2 codes 31572 & 31574 together?
    2- Is there a modifier to unbundle them?
    3- Any suggestions?
    Code ending 72 is with laser to destroy a lesion and the code ending 74 is a therapeutic Injection via endoscope, but to me are 2 different procedures when done @ different anatomical sides.

    Can you explain?

Leave a Reply

Your email address will not be published. Required fields are marked *