Latest changes in Otorhinolaryngology.
Latest changes in Otorhinolaryngology: CPT(R) 2017 brings several code changes for Otorhinolaryngology, a specialty that has seen few, if any, code changes in the past several years. The changes are primarily new codes, with some code revisions, to keep the codes up to date with contemporary clinical practice.
The laryngoscopy codes revised for 2017, and what?s different from 2016, are shown in Table A. These procedures involve the use of a flexible laryngoscope and are typically performed in the office setting, but may occur in the operating room.
New guidelines state not to report 31575 with 31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure), unless both are performed for separate conditions using separate endoscopes. Reporting both codes is not common, as both procedures are performed transnasal. The clinical rationale to support both codes should be documented clearly if both are reported. Both procedures should be separately documented, as well.
New flexible laryngoscopy codes allow us to report procedures more commonly performed by otolaryngologists in the past several years. These procedures are also typically performed in the office setting, using a flexible laryngoscope, but may occur in the operating room. Here are the 2017 codes, with examples for practical application:
- 31572Laryngoscopy, flexible; with ablation or destruction of lesion(s) with laser, unilateral. Code 31572 includes the removal of any number of lesions using the laser.
- 31573Laryngoscopy, flexible; with therapeutic injection(s) (eg, chemodenervation agent or corticosteroid, injected percutaneous, transoral, or via endoscope channel), unilateral. Code 31573 includes one or more injections at the same session.
- 31574Laryngoscopy, flexible; with injection(s) for augmentation (eg, percutaneous, transoral), unilateral. Code 31574 includes one or more injections at the same session. The procedure is commonly known as a percutaneous injection laryngoplasty.
All of these laryngoscopy codes are unilateral, which means modifier 50 Bilateral procedure may be appended if performed on both paired structures of the larynx/pharynx. CPT(R) guidelines state paired structures include true vocal cords, arytenoids, false vocal cords, ventricles, pyriform sinuses, and aryepiglottic folds.
There are six new, three revised, and two deleted codes in the Larynx Repair section of CPT(R) 2017.
Direct laryngoscopy and bronchoscopy are included in all the open larynx repair codes for airway evaluation prior to the definitive procedure at the same operative session.
The following four codes reflect procedures for resection of laryngeal stenosis. These codes are differentiated by the age of the patient, and whether an indwelling stent was placed.
CPT(R) codes for patients younger than 12 years of age:
- 31551Laryngoplasty; for laryngeal stenosis, with graft, without indwelling stent placement, younger than 12 years of age
- 31553 for laryngeal stenosis, with graft, with indwelling stent placement, younger than 12 years of age
CPT(R) code for patients aged 12 years or older:
- 31552Laryngoplasty; for laryngeal stenosis, with graft, without indwelling stent placement, age 12 years or older
- 31554 for laryngeal stenosis, with graft, with indwelling stent placement, age 12 years or older
The graft harvest and placement is included in the above codes and should not be separately reported, even when performed through a separate incision.
The remaining two new airway CPT(R) codes are for specific procedures:
- 31591Laryngoplasty, medialization, unilateral. Code 31591 is typically performed for vocal fold paralysis.
- 31592Cricotracheal resection. Code 31592 is usually performed for subglottic stenosis.
There are three revised airway procedure codes in 2017. These are listed in Table B, with an explanation of the difference in code description from 2016.
Two airway procedure codes, 31582 and 31588, were removed to correspond with the new and revised codes, noted above.
Deletion of the ?moderate sedation included? symbol () affected many otolaryngology endoscopy codes, such as 31615 Tracheobronchoscopy through established tracheostomy incision, the bronchoscopy codes (Eg: 31622 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure)), and many esophagoscopy codes (Eg: 43200 Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)).