Otolaryngology Coding Alert

You can replace 31599 and 92700 with 31545-31546

Two new codes for laryngoscopy procedures and one code for tinnitus evaluations will reduce your workload in 2005. 

Otolaryngology coders have to spend extra time handling claims containing unlisted-procedure codes. CPT 2005, however, eases your reimbursement problems with three new codes that describe previously undefined procedures. Codes 31545-31546 Eliminate 31599's Billing Burden You can say goodbye to filing 31599 for two procedures. Prior to CPT 2005, "no code combined laryngeal tumor removal with reconstruction," says Asia Evans, coding specialist at Head and Neck Surgery Associates, which has seven otolaryngologists, in Indianapolis. "Having specific codes that describe all these components will be great for otolaryngologists."

Old way: In 2004, coders should have reported the complex laryngoscopy procedure with unlisted-procedure code 31599 (Unlisted procedure, larynx), says Charles F. Koopmann Jr., MD, MHSA, professor and associate chair at the University of Michigan's department of otolaryngology in Ann Arbor. "CPT contained no code for visually enhanced [telescopic] mucosal removal of a benign neoplasm with a mucosal flap or a flap and autograft."

Problem: When you had to use 31599 to describe a laryngoscopy with biopsy and flap reconstruction, "reimbursement was uncertain," says Richard W. Waguespack, MD, FACS, the American Academy of Otolaryngology Head and Neck Surgery's (AAO-HNS) adviser to the AMA CPT Panel. Because an unlisted-procedure code contains no relative value units, insurers can decide how much to pay for the operation. Therefore, otolaryngologists had no way of ensuring that they would receive appropriate procedural payment.

You also had to spend more time filing the claim. When you submit a claim containing an unlisted-procedure code, you have to send in supporting documentation, including a letter explaining the surgeon's work and the operative notes.

Many payers separate the documentation from the claim on initial submission. So, you either have to wait for the insurer to request the additional information or resend the documentation. In either case, the procedure delays payment. Luckily, CPT makes these reimbursement hassles a thing of the past for two laryngoscopy procedures.

New way: Starting Jan. 1, you'll have two specific codes to report laryngoscopies that involve lesion removal and flaps. "You should use these new codes when the otolaryngologist performs a submucosal removal of a benign neoplasm and reapproximates the mucosal flap or places a graft," Koopmann says. The codes will read:

31545 - Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with local tissue flap(s)

31546 - Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal    removal of non-neoplastic lesion(s) of vocal cord; reconstruction with graft(s) (includes obtaining autograft). Technical Advances Call for New Larynx Codes To avoid using an unlisted-procedure code, some coders may have [...]