Otolaryngology Coding Alert

Question: I have received numerous denials of medical necessity on fiberoptic laryngoscopy (31575) for globus because the code, apparently, is not on local coverage determination (LCD). How can I reverse this policy to our favor?New Jersey SubscriberAnswer: You can try for an appeal. You will probably lose at redetermination level (the first level) because carriers just look at the LCD, but you might win at the next level, reconsideration. Medicare carriers have to use a panel of physicians when it is a medical necessity issue. You want to make your case by providing literature and clinical references and reasons why it is medically necessary to perform the scope for globus, (784.99, Other symptoms involving head and neck), a feeling of a lump in the throat.The physician has to visualize the larynx and surrounding sturctures to check if there is anything creating that sensation in the patient and the only way [...]