Otolaryngology Coding Alert

When an otolaryngologist performs an evaluation and management service and a flexible laryngoscopy on a patient on the same day, the chances of getting reimbursement rise dramatically if the decision-making portion of the E/M supports the medical necessity of using the scope.

Increasingly, carriers are including flexible laryngoscopy 31575 (laryngoscopy, flex-ible fiberoptic; diagnostic), also known as nasopharyngeal laryngoscopy (NPL) as part of the E/M services otolaryngologists provide to their patients. It is no coincidence that growing numbers of otolaryngologists have been performing NPLs on their patients during the course of a routine examination in place of indirect laryngoscopy 31505 (laryn-goscopy, indirect [separate procedure]; diagnostic), commonly referred to as the mirror.

In a policy statement aimed presumably both at insurance carriers and their own membership, the American Academy of Otolaryngology-Head and Neck Surgery has stated that flexible laryngoscopy should NOT be considered a routine part of the initial visit by a patient. In other words, it is not simply a high-tech replacement for a mirror.

The procedure, which can be performed in the otolaryngologists office, involves inserting a flexible fiberoptic laryngoscope through the nose or mouth to examine the interior of the larynx and offers unique information in the functional and anatomic assessment of the upper airway, according to the AAO-HNS policy statement.

Unlike indirect laryngoscopy, which is included in any E/M service code , the NPL is not a bundled procedure. It also should not be confused with 31515 (laryngoscopy direct, with or without tracheoscopy; for aspiration), which is a hospital-based procedure. It is also worth noting that a nasal endoscopy can turn into a flexible laryngoscopy if the otolaryngologist decides he or she wants to view deeper down the patients throat.

You would convert a 31231 (nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) or a 31237 (nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]) to a 31575, for example, when examining a patient who has sinus problems but also has indication for gastro-esophageal reflux disease (GERD), says Barbara J. Cobuzzi, MBA, CPC, CHBME, president of Cash Flow Solutions, a coding and reimbursement firm in Lakewood, NJ.

Note: CPT codes 31231 and 31237 also may convert to 31576 (laryngoscopy, flexible; with biopsy) or 31578 (with removal of lesion).
  10 Indications for Use of Endoscope

1. Macroglossia preventing mirror examination.
2. Gag reflex preventing mirror examination
3. Trismus preventing mirror examination.
4. Patient unable to cooperate to allow mirror examination
due to age (e.g., infants) or mental condition (mental
retardation, dementia, etc.)
5. Hoarseness, dysphasia, aspiration [...]