Like all other specialties, ENT practices have their own unique billing challenges. That is especially true for diagnostic procedures. Why does this matter? Because improper documentation and coding directly impact revenue and compliance.
One diagnostic procedure that is frequently performed in ENT practices is flexible laryngoscopy, represented by CPT code 31575. However, despite its frequent use, many billers fail to report it correctly. To save you from this ordeal, our billing experts at MediBillMD have compiled this detailed guide on CPT code 31575. So, let’s start.
CPT Code 31575 – Description
CPT code 31575 represents “Laryngoscopy, flexible fiberoptic; diagnostic.” This code falls under the American Medical Association’s (AMA) ‘Endoscopy Procedures on the Larynx’ category.
The procedure involves using a thin, flexible tube equipped with a light and camera (fiberoptic laryngoscope) to examine the larynx (voice box). The physician inserts this instrument through the nose and guides it down to visualize the vocal cords, surrounding tissues, and related structures.
The flexible laryngoscopy is a minimally invasive medical procedure. It is usually used to:
- Assess vocal cord function and movement.
- Identify structural abnormalities in the larynx.
- Evaluate swallowing function.
- Detect lesions, polyps, or other tissue changes.
- Monitor treatment progress.
However, please note that CPT code 31575 is only used to bill the diagnostic part of the treatment. It does not involve any therapies or medications. For these purposes, other more relevant CPT codes are used.
Scenarios Where CPT Code 31575 is Applicable
Let’s now look at a couple of scenarios in which CPT code 31575 is applicable.
Chronic Hoarseness Evaluation
Suppose a 45-year-old man visits the hospital and complains that he has been experiencing hoarseness for the past six weeks. He reports voice fatigue and occasional throat pain after speaking for extended periods. To diagnose the condition, the ENT specialist performs a flexible laryngoscopy, evaluates vocal cord function, and identifies potential causes.
During the examination, the physician observes bilateral vocal cord nodules consistent with vocal abuse. The diagnostic laryngoscopy helps confirm the diagnosis and guides treatment planning. Hence, CPT code 31575 is appropriate for this diagnostic evaluation.
Dysphagia Diagnosis
A 68-year-old patient visits the clinic complaining of difficulty swallowing solids and liquids over the past month. He reports occasional choking episodes and weight loss. This can happen for a variety of reasons. However, to pinpoint the actual reason, the physician performs a flexible laryngoscopy.
The examination reveals reduced vocal cord mobility on the left side, suggesting possible vocal cord paralysis. Therefore, CPT code 31575 accurately fits this diagnostic scenario.
Applicable Modifiers for CPT Code 31575
| Modifier | Description | Usage Guidelines |
|---|---|---|
| 22 | Increased Procedural Services | Apply when the laryngoscopy requires significantly more work than typical due to patient anatomy or clinical complexity. |
| 52 | Reduced Services | Apply when the procedure is partially reduced or eliminated at the physician’s discretion. |
| 59 | Distinct Procedural Service | Indicates the laryngoscopy is distinct from other procedures performed on the same day. |
| 76 | Repeat Procedure by Same Physician | Use when the same physician repeats the laryngoscopy on the same day due to technical or clinical necessity. |
An important thing to note about the modifier usage with 31575 is that CPT code 31575 typically does not require bilateral modifiers since the flexible laryngoscopy procedure examines both sides of the larynx during a single insertion. So, for this code, you must use “0” as the bilateral surgery indicator.
CPT Code 31575 – Billing & Reimbursement Guidelines
You must pay heed to the following factors while billing for CPT code 31575 to prevent claim denials.
Medicare Reimbursement Rates
As per the latest Medicare Physician Fee Schedule national average reimbursement rate for CPT code 31575 is $123.89 for non-facility settings. Let’s now discuss the estimated cost breakdown of 31575 in different settings.
Ambulatory Surgical Centers are a more budget-friendly option for patients. In these settings, patients only have to pay $30 out of their pockets. The total cost of the procedure is about $150, and Medicare covers $124 of this expense. The total cost of $155 is broken down into a $67 physician fee and a $88 facility fee.
Hospital outpatient departments are significantly more expensive, requiring $51 from patients. The total cost jumps to $261, with Medicare paying $208. While the physician fee remains the same at $67, the facility fee more than doubles to $194.
Documentation Requirements
For successful reimbursement of CPT code 31575, the following medical records are required:
- Clinical indication: Clear description of symptoms or conditions necessitating the examination.
- Procedure details: Type of instrument used (e.g., flexible fiberoptic laryngoscope).
- Anatomical findings: Detailed description of structures examined and any abnormalities identified.
- Patient tolerance: How the patient tolerated the procedure.
- Clinical impression: Diagnostic conclusions based on findings.
- Physician signature: Legible signature with date and time.
Common Billing Errors
A lot of billers make a common mistake while filing claims for 31575, which is using it in combination with other codes.
Never report CPT 31575 (diagnostic laryngoscopy) together with CPT 31579 (laryngoscopy with stroboscopy) for the same session. Code 31579 includes the diagnostic component, making 31575 bundled and inappropriate for separate billing.
Wrapping Up
CPT code 31575 is an essential and frequently used billing code in ENT practices. While it represents a simple procedure, its billing can be a bit tricky. Success in billing this procedure depends on understanding its proper application, maintaining thorough documentation, and applying appropriate modifiers when necessary.
If you are facing frequent claim denials or your revenue collection isn’t as expected, contact our billing experts at MediBill MD for the best ENT billing services. Our services can boost your revenue collection by up to 15%.
