Wiki Subglottic Tracheal Stenosis

Bobby A

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Can someone help me with this. I was thinking 31528 for one of the codes but I am just lost.
Pre-op Diagnosis: Subglottic tracheal stenosis
Post-op Diagnosis: same
Procedure Performed:  Microsuspension laryngoscopy, bronchoscopy, resection of tracheal stenosis, balloon dilation with Boston balloon with mitomycin-C, Kenalog injection.

DESCRIPTION OF PROCEDURE:
Patient was brought in the operating room and placed on table in supine position.  After good mask airway was able to be achieved, Dedo laryngoscope was put into place and suspended over tooth guards.  Given the patient's quick desaturations, patient was intubated through the scope as needed throughout the case.  Initially, a 5.0 tube was placed.  Following dilations, a 6-1/2 was able to be placed.  The subglottic tracheal stenosis was visualized using the bronchoscopic telescope.  Incisions were made at 9:12 a.m. and 3:00 a.m. with a Omni guide CO2 laser.  Mitomycin-C coated Boston balloon was then employed  to dilate the stenosis twice.  The patient could withstand only approximately a minute and half of dilation.  Following this, Kenalog 40 was injected along the periphery of the stenosis.  The patient appeared to tolerated the procedure well.  She was intubated at the end of the case with a 6 and half tube .  At this time, she is in the process of being extubated.  She appears to have tolerated the procedure well.

Thank you
 
31570: Laryngoscopy, direct, with injection into vocal cord(s), therapeutic
31540: Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis (lasar destruction of stenosis)
31528: Laryngoscopy direct, with or without tracheoscopy; with dilation, initial

Surgeon should have indicated if the dilation was initial or a subsequent dilation. I am making an assumption here.
 
Is a steroid injection into the subglottic stenosis coded with 31599 or 31570/31571? If it is coded with 31570/31571 could you explain why? CPT 31570 is injection into the vocal cord(s) Thank you for your expertise.
 
Subglottic area is below vocal cords.
The more I think about it and as you point out, I guess injection of steroids into the subglottic area should be unspecified code 31599. But I would equate 31599 to 31570 for pricing, since it is an injection using a laryngoscope and it is a similar area, just further down in the larynx.
 
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