Otolaryngology Coding Alert

Question: Our otolaryngologist administered a laryngeal injection through a flexible scope. How should I code this??

Minnesota Subscriber 

Answer: Your best choice when reporting injections through the operating port of a flexible fiberoptic or flexible distalchip laryngoscope is 31599 (Unlisted procedure, larynx).

Here’s why: CPT^® includes codes 31570 (Laryngoscopy, direct, with injection into vocal cord[s], therapeutic) and 31571 (Laryngoscopy, direct, with injection into vocal cord[s], therapeutic; with operating microscope or telescope) for injections performed using a rigid, direct laryngoscope which is introduced into the larynx via the patient’s mouth. These codes are not appropriate for injections performed using either flexible fiberoptic or flexible distal-chip endoscopic guidance where the scope is introduced via the patient’s nose as your physician used.

However, if the scope provided guidance for a percutaneous injection, you would code 64617 (Chemodenervation of muscle[s]; larynx, unilateral, percutaneous [e.g., for spasmodic dysphonia], includes guidance by needle electromyography, when performed).