Wiki Endocopic excisional removal base of tongue mass coding help

MChase928

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Please give me your input on coding for the following procedure.

PROCEDURE PERFORMED: Microdirect layngoscopy with excisional removal of 4.5 x 3 cm left base of tongue mass.
OPERATIVE PROCEDURE: Patient was placed in supine position. Routine induction carried out. The patient underwent intubation with a GlideScope. It was placed on the right side, and we were able to cannulate the airway and intubate the patient. At this juncture, attention was then turned to a large supraglottic oropharyngeal tumor that appeared to be attached to the left base of tone and extending from the lateral base of tongue to the midline. The overall size of the tumor was estimated at 4.5 cm in a vertical dimension and 3 cm wide. Under suspension laryngoscopy, up-biting forceps were used to remove the tumor piecemeal. It appeared to be adjerent to the left base of tongue muscle, and 90% to 95% of the tumor was removed. Care was taken not to injure the underlying tissue and to enter the lateral pharyngeal area.

The surgeon believes it should be coded 31526 and 41113. (diagnostic esophagoscopy and bronchoscopy were also performed and that coding is not in question). I coded the above 31541 as a laryngoscope was used in the mass excision and was not performed by direct visualization. Which code(s) is more appropriate? Thanks in advance for your comments and advice.
 
If a laryngoscope was used to remove the tumor, this would be a 31540, laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis;.
It's not a MICRO-direct, 31541, unless a microscope was brought into the field and used, which the documentation doesn't supposrt above.
If a laryngoscope wasn't used to remove the tumor, then the 31526 and 41113 would work, if he went back into the mouth with separate instrumentation and (using a mirror?) resected the base of tongue tumor AFTER investigating everything with the laryngoscope. But I have used these together before and some payers don't allow both of them, even though there isn't an NCCI edit.
Hope that helps.
 
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