Question Montgomery medialization Thyroplasty


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It appears that the previous code for this procedure, 31588, was deleted in 2016-2017...There is no direct replacement, I am looking at 31591 as the closest code that might work. Has anyone used this code for the Thyroplasty with implant/graft? Has anyone used a different code for this type of procedure. ENT is a new specialty for me. Thank you.


Grantsville, UT
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There is an article from CPT Assistant that is helpful on this topic.
Larynx Repair. April 2017; Volume 27: Issue 4
In it they discuss how there are new codes since 31588 was deleted. These were revised when 31588 was reviewed because they found several inabilities to capture age related differences among other particularities. Therefore, 31588 was deleted to remove coding ambiguity. This code was most frequently used to medialization laryngoplasty and now this procedure is most commonly reported with 31591 for open medialization of a vocal cord, removal of cricoid and part of the upper trachea, usually only one or two rings, all to treat subglottic stenosis. It goes on to state that tracheostomy is inherent to 31584, but not 31591, and can be reported separately. Graft harvests are also reported separately, but only if performed through a separate incision.

Here is the lay description and clinical responsibility for 31591.
The provider restores function of the larynx, or voice box, by moving a displaced or paralyzed vocal cord, which is displaced to one side, back toward the midline (medialization) in order to improve breathing, vocalization, and swallowing.

Clinical Responsibility
When the patient is appropriately prepped and anesthetized, the provider makes a small incision in a skin crease over the larynx and cuts a hole in the larynx to gain access to the vocal cord. He inserts an implant, graft, or other material into the larynx so that it moves the vocal cord toward the midline. He passes a flexible laryngoscope through the nose, which has been sprayed with lidocaine anesthetic, and into the throat to examine the vocal cord position and make any needed adjustments. During this part of the procedure, the patient is allowed to recover a bit from anesthesia and asked to make sounds. If no more adjustments are needed, the provider controls any bleeding and closes the incision.

Hopefully this information helps you to determine if 31591 is the correct code supported by the documentation.
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