If you work with larynx CPT® codes changes, you’ve probably been frustrated at some point by how coding for laryngoscopies can seem to take longer than the procedures themselves. Even the most involved laryngoscopies typically take less than 45 minutes, so why is coding for such a short procedure so complex?
A lot of the challenge stems from not understanding what separates direct, flexible, and open laryngeal repair codes, explains certified physician coder Barbara Cobuzzi in one of the Otolaryngology sessions of ProfEdOnDemand’s 2019 Coding Updates Virtual Boot Camp. As part of her 4-part training series covering new otolaryngology CPT® codes, Cobuzzi details the benefits—and limitations—of each laryngeal repair procedure and how to carefully and properly code for payment.
Here’s a quick preview you can use to upgrade your larynx repair coding:
Use 3 Clues to Detect a ‘Direct’ Laryngoscopy
Before digging into laryngoscopy types (codes are found within the 31500/31600 sections), it’s key to know why the procedure is done in the first place.
The larynx, located at the top of the trachea in the back of the throat, performs essential functions such as breathing, swallowing, and talking; it also houses the vocal cords. So when there’s an issue with any one of these functions, a laryngoscopy is the first step to addressing the problem. The procedure varies from minimally invasive to very invasive depending on the severity of the issue.
The most involved laryngoscopy would be a direct laryngoscopy, where the physician uses a laryngoscope to push down the tongue and lift up the epiglottis. This procedure type is also the one reserved for more urgent issues, such as helping a patient breathe during an emergency. It is also what’s used to extract tissue samples or growths for further investigation.
To bill for a direct laryngoscopy, check first for the following clues:
- How long did the procedure take? Direct laryngoscopies typically take up to 45 minutes.
- Why did the physician perform the procedure? If it was done in response to an urgent issue (such as difficulty breathing), it was probably a direct laryngoscopy.
- Did the physician order anesthesia? Due to the more invasive nature of a direct laryngoscopy, patients receive general anesthesia.
If you can’t find evidence of the above criteria in the documentation, you’re probably dealing with one of the other two types of procedures described below.
Take 10 for a ‘Flexible’ Laryngoscopy
In a flexible laryngoscopy, the physician uses a small telescope at the end of a cable to see down the throat. Quite short, this procedure takes less than 10 minutes.
Another hint: Besides the amount of time spent, the type of medication used can help you determine if this was a flexible laryngoscopy. Physicians give numbing medication for the nose (since the cable goes up the nose before then going down the throat). If needed, the otolaryngologist also gives a nasal decongestant to open up the nasal passage.
Open Laryngeal Repair: Check for Multiple Surgical Sessions
While laryngoscopies are for exploring, otolaryngologists use laryngeal reconstruction to make repairs. These repairs are done either via an endoscopic approach (where instruments are inserted into the mouth to reach the airway) or traditional open-air surgery. If the patient and physician opt for the open approach, surgery can take either one go or multiple sessions.
To bill for open laryngeal repair, look for the following:
- Why was the procedure done? Open laryngeal repairs provide long-term solutions to issues such as stenosis (narrowing of the airway), malformation of the larynx, or vocal cord paralysis.
- What is the patient’s age? Since laryngeal development issues typically occur as birth defects, open laryngeal repairs are much more commonly performed on children.
- How many sessions were performed or are planned to be performed? Check the documentation to see if multiple sessions have occurred or are planned, and bill for the appropriate session.
Larynx CPT Code Changes: Get the Latest Scoop
Coding for laryngeal repair procedures can be complex and confusing. Understanding the differences between procedure types—as well as how to code for procedure plus biopsy—is just your first step. Take the next step by bolstering your overall otolaryngology coding power with help from Barbara Cobuzzi in her 4-part series during the 2019 Coding Updates Virtual Boot Camp. You’ll get an inside scoop on the latest larynx CPT® codes changes, and how to apply them to each of the different procedures.
