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Otolaryngology Coding Alert

READER QUESTIONS:

Looking for Tonsil Biopsy Code? Check for Scope

Published on Thu Aug 27, 2009

Question: My physician did a punch excisional biopsy of the left tonsil, but I'm not seeing a code for this. What should I do? Kentucky Subscriber Answer: You don't see a code, because no specific code exists for a biopsy of the tonsils. You should instead report the code based on whether the otolaryngologist used a scope. If he didn't, you should assign 42800 (Biopsy; oropharynx). If the physician used an endoscope, you should report 31535 (Laryngoscopy, direct, operative, with biopsy) or 31536 (... with operating microscope). Note: CPT classifies "indirect" laryngoscopy as an endoscopy, even though the procedure requires a mirror, not an endoscope.  Answers to You Be the Coder and Reader Questions provided/reviewed by Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.
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