Otolaryngology Coding Alert

Question: During our routine comprehensive office exam, we also perform indirect laryngoscopy to view the larynx and hypopharynx. Is it appropriate to charge for 31505 (laryngoscopy, indirect; diagnostic [separate procedure]) in addition to our office visit? Or is this procedure considered a normal part of the exam?

Robert S. Thornton, MD, LA

Answer: If the indirect laryngoscopy (commonly known as the mirror) is used during a routine examination, it should not be billed separately, says Barbara Cobuzzi, MBA, CPC, CHBME, president of Cash Flow Solutions, a physician reimbursement consulting firm in Lakewood, NJ. Usually, the otolaryngologist will use the mirror during the course of a normal otolaryngological examination. The procedure is included as part of the evaluation and management (E/M) service and should not be billed separately.

If the mirror is used for a specific condition or symptom, however, it may be billed separately from the examination. In that case, the appropriate level of E/M service would be coded with modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) attached.

Indirect laryngoscopy also may be billed if that is all the physician saw the patient for. For example, if a patient suffering from hoarseness already had received a flexible laryngoscopy (31575) and, when following up with the patient, the otolaryngologist uses the mirror to to inspect how the patient is doing, no E/M may be billed, but the otolaryngologist can charge for the 31505.