Otolaryngology Coding Alert

Don't bill for looking at the larynx or pharynx before performing 43200-43232. The latest version of NCCI includes diagnostic laryngoscopy and nasopharyngoscopy with esophagoscopy.

The National Correct Coding Initiative (NCCI), version 9.2, effective July 1, bundles the following codes with esophagoscopy procedures (43200-43232):
  31505 Laryngoscopy, indirect; diagnostic (separate procedure)
  31525 Laryngoscopy, direct, with or without tracheoscopy; diagnostic, except
 newborn
  31575 Laryngoscopy, flexible fiberoptic; diagnostic
  92511 Nasopharyngoscopy with endoscope (separate procedure). Including diagnostic laryngoscopies and nasopharyngoscopy with esophagoscopy procedures follows accepted coding principles. Thus, the edits shouldn't shock most coding experts. "None of these changes will affect the daily billing in our office," says Shawn Langston, CPC, coder for Mitchell D. Kaye, MD, FACS, in Hopkinsville, Ky. Don't Bill Diagnostic Laryngoscopy With Esophagoscopy These edits follow correct coding guidelines, which allow you to bill for the most extensive scope used, if the component scope does not result in a surgical procedure. "Similar to gastrointestinal coding for colonoscopies, if a physician uses a scope and pushes it in, stops and evaluates the area, and then pushes the scope further in, you may only bill for the farthest area that the scope reaches," says Barbara J. Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J.

Of course, with otolaryngology, the ENT uses multiple scopes. He usually inserts one scope, the laryngoscope (for instance 31575), pulls it out and puts in the second scope, an esophagoscope (such as 43200, diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]), Cobuzzi says. Because the esophagoscopy (43200) includes the diagnostic laryngoscopy (31575), you may report only the most extensive scope performed: the esophagoscopy (43200).

Similarly, if a surgeon looks at a patient's nasal passages and pharynx using a flexible fiberoptic endoscope (92511) and also uses an esophagoscope to view the patient's esophagus (43200-43232), you should not separately report the nasopharyngoscopy (92511), Cobuzzi adds.

Some otolaryngologists, however, separately bill for the diagnostic laryngoscopy or nasopharyngoscopy when they perform esophagoscopy only, says James N. Palmer, MD, assistant professor in the division of rhinology in the department of otorhinolaryngology, head and neck surgery at the University of Pennsylvania in Philadelphia. "If a surgeon uses an esophagoscope and looks at the patient's larynx on the way down, that's not sufficient reason to bill the diagnostic laryngoscopy," he says.

The edits contain an indicator of "0." Therefore, NCCI does not permit using a modifier, such as modifier -59 (Distinct procedural service), to unbundle the laryngoscopy or the nasopharyngoscopy during the same procedural encounter. 31575-31579 Include Looking at the Sinuses NCCI also targets flexible fiberoptic and rigid laryngoscopy codes (31575-31579), which now include sinus endoscopy (31231, [...]