Question CO2 laser of subglottic cyst

Manders21

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The doctor did a CO2 laser ablation of subglottic cysts. The only code I can find is 31572 but it says laser ablation with lesion. So since it is a cyst and not a tumor can I still use this code? Or could this be inclusive with one of the other procedures. So far I have codes 31561 and 31528 that I can bill. Here is the report:

Procedure: Direct laryngoscopy, bronchoscopy, CO2 laser ablation of subglottic cysts, CO2 laser epiglottopexy, balloon dilation of subglottic stenosis, right endoscopic arytenoidectomy

Details: Using a philips laryngoscope the supraglottic structures were evaluated, posterior prolapse of the epiglottis was noted with anterior prolapse of the left arytenoid indicative of laryngomalacia. Diffuse edema and cobblestoning was noted of the laryngeal structures and posterior pharyngeal wall. Using a hopkins rod the glottic introitus was entered. The immediate subglottis was inspected which revealed 3 adjacent cysts each approximately 2-3 mm on the right wall of the subglottis resulting in grade 1 subglottic stenosis. The proximal and distal trachea were also notable for diffuse edema and cobblestoning. The right and left mainstem bronchi were without abnormality. No bronchomalacia or foreign bodies were observed.

Patient's supraglottis was identified and isolated using a Lindholm laryngscope. Upon doing so, the laryngoscope was suspended and secured on the Mayo stand. The patient's head was then wrapped in wet towels. Anesthesia switched to room air for ventilation. A hopkins rod was used to visualize the epiglottis. The CO2 laser was then aimed and fired at the lingual surface of the epiglottis in the midline in an anterior to posterior direction, pulling the epiglottis anteriorly. The was repeated in the midline followed by the right and left sides of the lingual surface of the epiglottis until adequate anterior lift the epiglottis was achieved.

Next, the subglottis was visualized with the hopkins rod. The subglottic cysts were identified. After patient was again switched to room air, the CO2 laser was then aimed and fired at the 3 subglottic cysts on the right wall of the subglottis until they were ablated. Once the cysts were adequately ablated, a 10mm airway balloon was introduced into the subglottis and inflated to 15mmhg for approximately 1 minute, until patient started to desaturate into high 80s. The balloon was deflated and removed. The subglottis was reinspected with the hopkins rod and satisfactory dilation was achieved.

Next, using the hopkins rod and microlaryngeal scissors, the left arytenoid was then isolated and using a straight cup forcep and curved microlaryngeal scissor, the redundant arytenoid tissue was removed. All bleeding was controlled using afrin pledgets. Hemostasis was achieved. The stomach was suctioned. Patient was then turned over to anesthesia. Anesthesia was then reversed and the patient was transported to the recovery room having tolerated the procedure well with stable signs.
 

b.cobuzzi

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A cyst is a lesion, it is a benign lesion. I would not use 31572 because that is a flexible laryngoscope that is put through the nose. In this case a direct laryngoscope is used. There is no code that describes a direct laryngoscopy with removal of a lesion via laser. You will have to use 31599 unlisted code and equate it to 31540 ( Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis) which is an excisional removal of a lesion or cyst via laryngoscope. Ask your surgeon whether is more than 100% of 31540 so you can indicate the % of 31540 in Box 19 of the claim.

There is also no code for balloon dilation of the subglottis. So, in box 19, you need to say that 31599 is equal x% of 31540 for laryngoscopic laser destruction of subglottic cyst PLUS y% of 43220 for laryngoscopic balloon dilation of the sublottis.

43220 is Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter)

It looks like a 31560 was also performed (Laryngoscopy, direct, operative, with arytenoidectomy)
 

Manders21

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A cyst is a lesion, it is a benign lesion. I would not use 31572 because that is a flexible laryngoscope that is put through the nose. In this case a direct laryngoscope is used. There is no code that describes a direct laryngoscopy with removal of a lesion via laser. You will have to use 31599 unlisted code and equate it to 31540 ( Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis) which is an excisional removal of a lesion or cyst via laryngoscope. Ask your surgeon whether is more than 100% of 31540 so you can indicate the % of 31540 in Box 19 of the claim.

There is also no code for balloon dilation of the subglottis. So, in box 19, you need to say that 31599 is equal x% of 31540 for laryngoscopic laser destruction of subglottic cyst PLUS y% of 43220 for laryngoscopic balloon dilation of the sublottis.

43220 is Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter)

It looks like a 31560 was also performed (Laryngoscopy, direct, operative, with arytenoidectomy)
Thank you!
 
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