Lingual tonsillectomy with epiglottopexy


Auburn Hills, MI
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Is an epiglottopexy inclusive to a lingual tonsillectomy? I don't see NCCI edits but since it's in the same area, I just wanted to check. Also, from my understanding an epiglottopexy is part of the supraglottoplasty procedure so can I still use cpt code 31561 or is there a different code for an epiglottopexy?

Procedure performed: Drug induced sleep endoscopy, lingual tonsillectomy, and supraglottoplasty (epiglottopexy)

Procedure details: After consent was obtained the patient was taken to the OR and laid supine on the table. Anesthesia was inducted. Time-out procedure was performed. First drug induced sleep endoscopy was perfomed. Flexible laryngoscope was passed through the right nasal passage. No adenoid pad was noted. No tonsils or lateral laryngeal wall collapse. The epiglottis was retroflexed and displaced anteriorly due to enlarged lingual tonsils, this is causing mild obstruction. At this time the decision was made to perform lingual tonsillectomy and epiglottopexy. Using a Lindholm laryngoscope, the epiglottis was elevated revealing enlarged lingual tonsil tissue. Using the coblator on the setting of 9 for ablation and 5 for coagulation along with the 4mm zero degree telescope the lingual tonsil was ablated and hemostasis was obtained. 2 times during the procedure the linholm laryngoscope was repositioned to adequately address more lateral lingual tonsil. Next epiglottopexy was performed. A small area of ablation was then placed on lingual surface of epiglottis with the intention to slightly scare the epiglottis anteriorly to provide a more open airway. The laryngoscope was carefully removed. The patient was then turned back to anesthesia in stable condition. The patient tolerated the procedure well. There were no complications.


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I think that only the Lingual tonsillectomy can be coded based on the documentation. If the doctor documented more for the epiglottis, I would consider putting a 22 modifier for increased service on the lingual tonsillectomy, but it does not look like you have enough to support the 22 modifier. Remember that since we are asking for more money with a 22 modifier, the documentation goes to the payer for review, so the support for more than 25% more complicated than a normal lingual tonsillectomy needs to be supported in the op note.