Otolaryngology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: A patient is referred to an otolaryngologist with a suspected cancer of the larynx. The physician schedules the patient for a direct laryngoscopy and esophagoscopy. The purpose of the esophagoscopy is to make certain that any lesion found in the laraynx has not invaded the esophagus. The physician subsequently found that the patient did have carcinoma of the larynx, and there was no invasion of the esophagus. What ICD-9 code should be used in billing for the esophagoscopy, especially to Medicare?

Anonymous West Virginia Subscriber

Answer: There are several diagnosis codes that will justify the esophagoscopy, says Randa Blackwell, a coding specialist with the department of otolaryngology at the University of Maryland in Baltimore, and your carrier should be able to provide a list of them. Because most patients with laryngeal cancer have dysphagia (an approved diagnosis for esophagoscopy), this diagnosis (787.2) should be used if it is appropriate under the circumstances.

The by-the-book way to report this situation is by using V-code V71.1 (observation for suspected malignant neoplasm), but this code may not be reimbursed. Therefore, from a reimbursement standpoint, it should be included as a second diagnosis. It is used for individuals without a diagnosis who are suspected of having an abnormal condition that requires study even though no signs or symptoms are present, but the abnormal condition is found not to exist after examination and observation.

Although Medicare does not recognize laryngeal cancer as a diagnosis for an esophagoscopy, many other carriers do, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding expert and educator in North Augusta, S.C. She suggests that in the absence of a payable diagnosis (e.g., dysphasia), coders should report that the patient has cancer in a nearby location.

In short, the first diagnosis that should be used for the esophagoscopy would be a payable diagnosis that is on a list obtained from the carrier, if appropriate. The nearby (laryngeal) cancer should be the second diagnosis for non-Medicare carriers, and V71.1 should be listed third (second for medicarecarriers).