Spur Your Understanding of Spasmodic Dysphonia
Know your treatment options and remember how to calculate wastage. Your otolaryngologist might diagnose a patient with spasmodic dysphonia when they present with narrowed or closed vocal cords that make it difficult to speak or breathe. This condition is also known by the alternate terms laryngeal dystonia or laryngeal spasms. Spasmodic dysphonia is a neurological disorder affecting the voice muscles in the larynx. It is characterized by involuntary movements or spasms of the vocal cords causing interruptions of speech and affecting voice quality. These disruptions can significantly interfere with speech, leading to a voice that may crack or sound strained or choked. Continue reading to learn more about the different types of spasmodic dysphonia and the current treatment options. Recognize Spasmodic Dysphonia Types There are three different types of spasmodic dysphonia: These conditions are all coded under one ICD-10-CM diagnosis code: R49.0 (Dysphonia). The cause of spasmodic dysphonia is often unknown, but it is believed to result from an issue in the brain and nervous system. It can sometimes run in families, suggesting a genetic component. Know the Treatment Options Common treatments for spasmodic dysphonia include voice therapy and the use of botulinum toxin (Botox) injections into the vocal cords to alleviate the severity of symptoms. The injections help to reduce the muscle spasms associated with this condition, thereby improving voice quality. Surgery may also be an option for some patients but is less common. It is important to note, however, that there’s no cure for spasmodic dysphonia currently, and the success of treatments can differ from one patient to another. If the otolaryngologist does administer a direct vocal cord injection into the patient’s neck to treat laryngeal spasm, an appropriate code would be 64617 (Chemodenervation of muscle(s); larynx, unilateral, percutaneous (e.g., for spasmodic dysphonia), includes guidance by needle electromyography, when performed). If you’re reporting injections on both the right and left vocal cords or folds, be sure to append modifier 50 (Bilateral procedure) and include clear documentation of both injections. If the otolaryngologist opts to inject the patient’s vocal cords directly using laryngoscopy, you will code this as 31570 (Laryngoscopy, direct, with injection into vocal cord(s), therapeutic) or 31571 (Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope or telescope). Your provider may opt to direct the injections toward the muscles experiencing spasms rather than the larynx itself. Typically, these are the thyroid arytenoid muscles that encircle the larynx. In that case, you will choose 64616 (Chemodenervation of muscle(s); neck muscle(s), excluding muscles of the larynx, unilateral (e.g., for cervical dystonia, spasmodic torticollis)). Code for Guidance if Used Practitioners frequently use electromyography (EMG) to assist in guiding the delivery of percutaneous injections. Depending on whether your provider used solely electrical stimulation or a needle, there are two coding alternatives for guidance: Be sure to add the appropriate code to your claim if the provider used additional guidance. Make note: The description of 64617 already includes needle guidance by EMG, so you cannot also report the add-on code +95874 with 64617 on the same claim. Calculate Botox Injections and Wastage Correctly The process of chemodenervation of the laryngeal muscles using onabotulinumtoxinA (Botox) generally involves a minimal dosage, often less than 5 units per muscle and frequently less than 0.5 cc. Due to the onetime use restriction and the relatively brief reconstitution shelf life of one day for the drug, it’s not unusual for medical practices to experience unavoidable wastage of onabotulinumtoxinA. To prevent drug wastage, many practitioners will often schedule patients who need Botox injections on the same day. However, if you do have Botox wastage, you should indicate this on your claims by using modifier JW (Drug amount discarded/not administered to any patient) and listing the amount of wastage as a separate line item. Here is an example displaying how to code for the 5 units of onabotulinumtoxinA being injected into the patient and the wastage from a 50-unit vial of Botox: Lindsey Bush, BA, MA, CPC, Production Editor, AAPC
