Otolaryngology Coding Alert

Question: Would you use 31535 to code a direct operative laryngoscopy with multiple biopsies? What modifier should I use? Modifier 76?

Tennessee Subscriber

Answer: Yes, but you should report this code for each biopsy. In other words, you should add modifier 59 (Distinct procedural service) to 31535 (Laryngoscopy, direct, operative, with biopsy) to indicate a separate location. For instance, if the physician did three biopsies, you would report 31535, 31535-59, and 31535-59.

Don't miss: Always send the codes with operative and pathology reports so you can avoid having to appeal Medicare or your private payers. Remember that modifier 59 documentation "must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of extensive injuries) not ordinarily encountered or performed on the same day by the same individual," according to CPT.

Beware: Never use modifier 76 (Repeat procedure or service by same physician) if you're not taking a biopsy at the same site. It means "repeat procedure," whereas modifier 59 tells payers this biopsy took place in a different location and involved a separate incision/ excision. Additionally, you should keep in mind that, although in direct violation of the definition, some payers only pay on modifiers 76 and 77 for diagnostic studies and testing, not for surgical procedures.