Otolaryngology Coding Alert

Avoid unbundling errors with scope guidelines' review

You can tackle CMS' latest round of coding edits that focus on new CPT codes 31545 and 31546, if you're up to snuff on basic laryngoscopy coding conventions. Standards Dictate No Lesion Removal With Excision The summer update to the National Correct Coding Initiative makes it clear you shouldn't report direct laryngoscopy with non-neoplasm removal and reconstruction in addition to larynx excision. Starting July 1, CPT 2005's two new laryngoscopy codes, 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]) and 31546 (... reconstruction with graft[s] [includes obtaining autograft]), become part of larynx excision codes 31300-31420.

You can't use a modifier to override the bundles for 31545-31546 with 31300-31420. These edits make sense, says Asia Evans, coding specialist at Head and Neck Surgery Associates in Indianapolis.

Why: Both 31545 and 31546 refer to lesion removal, while 31360-31395 refer to removing the larynx. "Clearly if you bill for taking the larynx out, you're not going to bill for taking a lesion off the vocal cord," Evans says. CMS Allows Billing 1 Laryngoscopic Removal When an otolaryngologist removes a lesion from the larynx, you should report only one laryngoscopic excision code per claim. NCCI version 11.2 now reinforces this directive by making direct laryngoscopy codes 31545 and 31546 mutually exclusive with other laryngoscopic lesion removal codes including:
  31512 - Laryngoscopy, indirect; with removal of lesion
  31578 - Laryngoscopy, flexible fiberoptic; with removal of lesion. "Mutually exclusive" means the otolaryngologist wouldn't perform these procedure together. "Our surgeons don't usually bill laryngoscopic lesion removal codes together," agrees Mary Hameister, reimbursement manager at Pediatric Ear, Nose & Throat of Atlanta.

An otolaryngologist may use a flexible scope to check the vocal cords prior to putting in a direct scope to finish the procedure in a different operative session. "But at an excision session, the surgeon usually just inserts the chosen scope and removes the lesion," Hameister says.

If an otolaryngologist does perform multiple lesion removals at the same session, you should bill only the most extensive procedures. "You can only get reimbursement for one treatment of a lesion at a time," says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C.

In addition, you shouldn't report 31545 plus 31546 due to mutually exclusive procedure rules. The otolaryngologist  uses either local tissue flaps (31545) or grafts (31546) for reconstruction following vocal cord tumor removal. Surgical Procedure Includes Diagnostic Scope Another laryngoscopy coding tenet that you should commit to memory is that an operative scope includes the diagnostic scope. NCCI applies this guideline to make two diagnostic laryngoscopy codes (31525, Laryngoscopy, direct, with or without tracheoscopy; [...]