Otolaryngology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: How should I code suspension microlaryngoscopy with Depo-medrol injection into the stenotic segment for subglottic stenosis, incision of scar in four quadrants, balloon dilation, and mitomycin-C application? Florida Subscriber

           
Answer: Although this may look like a complex operative note, look for keywords, such as microlaryn-goscopy, to point you in the right direction. From micro and laryngoscopy, we can assume a close or microscopic view of the larynx. CPT includes 27 codes for laryngoscopy with three types: indirect (31505-31513), direct (31515-31571) and flexible (31575-31579).

Direct laryngoscopy includes examining the pharynx and larynx directly with a laryngoscope that allows the surgeon to examine these structures thoroughly and to take a biopsy from suspicious-looking areas. The physician usually performs the procedure in an operating room under general anesthesia. In suspension microlaryngoscopy, the doctor suspends the laryngoscope to allow her to work with both hands, according to Bechara Y. Ghorayeb, MD, PA, an otolaryngologist with Otolaryngology-Head & Neck Surgery in Houston and clinical associate professor of otolaryngology at The University of Texas Medical School. The otolaryngologist uses a surgical microscope to provide magnification and better visualization and to deliver a LASER beam. Only direct laryngoscopy codes include using a microscope. Microlaryngoscopy is direct laryngoscopy with an operating microscope. So, this narrows your search to 31515-31571. Next, look at what procedures the otolaryngologist performed in addition to the microlaryngoscopy. Several terms stand out, including injection, dilation and application. The injection into the stenotic segment for subglottic stenosis is an injection of an anti-inflammatory steroid (Depo-medrol) into the lower larynx. This information immediately directs you to a therapeutic injection into the vocal cords. Now, you must choose between 31570 (Laryngoscopy, direct, with injection into the vocal cord[s], therapeutic) and 31571 (... with operating microscope). Because the notes designate a microscope, select 31571.