Question pls help answer question on 31575 per CPT anatomy components

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wynonna

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Hello fellow ENT coders:
Per CPT p. 215. 31575 Laryngoscopy contains a very long list of components of larynx which are included under 31575.
Does the provider need to list each and every component that he examines, or is the list meant as informational?
In other words, do I attach a mod 52 for reduced services if provider doesn't list every single component? For example, let's say he doesn't document ventricle or tongue base-but he documents every other component? (And he documented that the fiberoptic flexible scope was inserted into the nasal passage and advanced to the larynx/vocal cord level.)

thank you so much!
 
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The key to proper coding is the anatomic area (nasopharynx (92511), nasal (31231) or larynx (31575)) the ENT examines with the scope, it doesn't matter the approach as long as a scope is used and documented. I was told not all the "common areas of focus" had to be documented but it needed to point out the specifics of the main area of exam. 92511 is mainly nasopharynx, everything but the larynx, 31231 is mainly nasal and sinus and then 31575 is the oral and larynx area. I wouldn't worry about the tongue base being examined unless that is the DX you are appending. Hope that helps!
 
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All procedures have anatomical areas of focus that is defined by physicians in their medical practice to determine the medical necessity of a procedure. These are usually found in medical journals that is what Optum uses in their coder desk reference.
 
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wynonna said:
Hello fellow ENT coders:
Per CPT p. 215. 31575 Laryngoscopy contains a very long list of components of larynx which are included under 31575.
Does the provider need to list each and every component that he examines, or is the list meant as informational?
In other words, do I attach a mod 52 for reduced services if provider doesn't list every single component? For example, let's say he doesn't document ventricle or tongue base-but he documents every other component? (And he documented that the fiberoptic flexible scope was inserted into the nasal passage and advanced to the larynx/vocal cord level.)

thank you so much!
Click to expand...
Hello, per p. 215 in the CPT 2024 31575 the approach is nasal or oral via a flexible laryngoscope, the interior of the larynx is examined, now for each indentation under 31575 there are with.... i.e bx, etc the CPT tells you which codes to NOT code with 31575 so if the provider does a bx and and removal of lesion it STATES do not report with.... that is your guide as to each component coding or not to code. It can be confusing but its all spelled out in the CPT book under each code. Happy to help!
 
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Hello, As far as approach it does matter, and the type of scope, also common area's of focus not sure what that term means, but just break down you op report to approach, tools used, area's viewed and what was done i.e bx and the CPT tells you which codes DO NOT Code With.. Good luck
 
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Thank you all for your input. It is very helpful. I think my question concerns what the MD should be documenting in the note. If he doesn't note every area on page 215 under laryngoscopy, would I attach a modifier 52?
For example, If provider doesn't document that he examines the pyriform sinuses (noted under 31575 Endoscopy section on page 215 of CPT,) for example, do I need to attach mod 52 for reduced services?
I know we add mod 52 to nasal endoscopy when a location isn't documented- like the turbinates. I would love to hear from Barbara C on this.
 
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