CPT for ENT: Flexible Laryngoscopic Procedures

CPT for ENT: Flexible Laryngoscopic Procedures

Q: How do I code for percutaneous laryngeal injections using flexible endoscopic guidance?

A: Percutaneous laryngeal injections performed using flexible laryngoscopy for guidance and needle placement should be reported using the unlisted laryngeal code 31599.  In this setting, 31599 includes both the injection and the flexible laryngoscopy.  Depending on which material is injected, you might be able to separately report the material with a HCPCS J code.  CPT codes 31570 and 31571 are used to report injections performed using rigid, direct laryngoscopy and are not appropriate to use for injections performed using either flexible fiberoptic or flexible distal-chip endoscopic guidance.        

Q: What if the laryngeal injection is done through the flexible scope?

A:  Injections performed through the operating port of a flexible fiberoptic or flexible distal-chip laryngoscope are reported using the unlisted laryngeal code 31599.  CPT Codes 31570 and 31571 are used to report injections performed using rigid, direct laryngoscopy and are not appropriate to use for injections performed using either flexible fiberoptic or flexible distal-chip endoscopic guidance.       

Q:  Is flexible laryngoscopy using a distal chip scope also coded with 31575-31578?

A: Yes.  While the optics and video sensor of a distal-chip flexible laryngoscope are different from (and generally superior to) those of a standard fiberoptic laryngoscope with attached video camera, the technique and physician work involved in using the two instruments is identical.  Hence, 31575-31578 are used to report flexible laryngoscopy performed using either a fiberoptic (with naked eye or video observation) or distal-chip flexible laryngoscope.    

Approved May 2014

Important Disclaimer Notice (Updated 8/7/14)

CPT for ENT articles are a collaborative effort between the Academy’s team of CPT Advisors, members of the Physician Payment Policy (3P) workgroup, and health policy staff. Articles are developed to address common coding questions received by the health policy team, as well as to clarify coding changes and correct coding principles for frequently reported ENT procedures. These articles are not intended as legal, medical, or business advice and are not a guarantee of reimbursement. The information is also not meant to serve as the definitive or sole authority on billing and coding issues. The applicability of AAO-HNS billing and coding guidance for a particular procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. You should consult with your own advisors as well as Medicare or private carriers in making any decisions about how to bill and code particular services or procedures.