Otolaryngology Coding Alert

Question: After undergoing surgery for a knife wound to the neck, a patient requires medialization laryngoplasty for vocal-cord paralysis. How should I report the procedure?

Washington, D.C., Subscriber Answer: You should report 31599 (Unlisted procedure, larynx) for the medialization procedure.

Watch out: If fewer than 10 days transpire between your otolaryngologist performing the knife exploration (20100, Exploration of penetrating wound [separate procedure]; neck) and the medialization laryngoplasty (31599), you need a modifier to break 20100's global period. For a planned medialization laryngoplasty, you should append modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) to 31599. For instance, if your otolaryngologist performs 20100 (10 global days) and plans on performing the medialization laryngoplasty two days later, you should append modifier -58 to 31599 to indicate a staged procedure.

You should report 31599-78 (Return to the operating room for a related procedure during the postoperative period) when the patient needs the medialization laryngoplasty due to surgical complications.