Look to Etiology for Definitive VPI Dx
Question: What is the correct way to code for an augmentation pharyngoplasty for a diagnosis of velopharangeal insufficiency (VPI)? AAPC Forum Subscriber Answer: The correct CPT® code for this procedure would be 42950 (Pharyngoplasty (plastic or reconstructive operation on pharynx)). In this procedure, the surgeon reconfigures the shape of the soft palate and pharynx. This is typically performed to correct a number of conditions, including speech problems due to cleft palate, tonsillectomy complications, or reconstruction resulting from major resection due to malignant neoplasms of the oral cavity and pharynx. The ICD-10-CM coding for VPI is a little trickier because you must first determine its etiology. According to the National Institutes of Health, VPI “is a disorder of the velopharyngeal (VP) sphincter or valve, which separates the nasal and oral cavities during speech, swallowing, vomiting, blowing, and sucking.” However, the condition “can occur secondary to structural deficits, neurological disorders, faulty learning, or as a syndromic finding.” Given that the provider is correcting the condition surgically, however, the code you will use for the VPI for this encounter will be anatomical in nature, most likely Q38.8 (Other congenital malformations of pharynx). But in this case, unless the op note contains more details pointing you to a more specific diagnosis, it would be a good idea to query your provider before assigning a code. Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
