Otolaryngology Coding Alert

Your otolaryngologist will describe a laryngoscopy as using one of two different types of scopes: rigid and flexible. The code 31525 (Laryngoscopy direct, with or without tracheoscopy; diagnostic, except newborn) is for rigid laryngoscope; 31575 (Laryngoscopy, flexible fiberoptic; diagnostic) is for flexible laryngoscope.

Rigid: Physicians may use a rigid scope for surgical procedures, such as removing foreign objects, collecting tissue (biopsy), removing polyps, or performing laser surgery, says Denae M. Merrill,CPC-E/M, owner of Merrill Medical Management in Saginaw, Michigan. Physicians perform 31525 in the OR under sedation, which tells you that it is inappropriate to use in an office setting.

Flexible: On the other hand, a flexible scope allows better diagnostic views, is tolerated better by patients and can be performed in the office.

When your physician identifies a problem while performing a diagnostic scope, you should shift from reporting a diagnostic scope code to a surgical flexible scope code.

Example: An otolaryngologist documents a "direct laryngoscopy used to view the vocal cords by using a fiberoptic scope." While doing the procedure, he found and biopsied a polyp on the vocal cords (478.4, Polyp of vocal cord or larynx). Report 31576 (... with biopsy) instead of 31575 for a diagnostic laryngeal scope.