Healthcare providers frequently face coding issues in the realm of medical billing! So, if you are a healthcare provider or a member of the billing team, our series on various CPT Codes will prove to be a go-to resource for clearing up the coding confusion. In today’s guide, we will cover an ENT procedural code.
The unique nature of ENT services, varying payer policies, complex coding requirements, and specific patient situations make ENT billing quite challenging. Therefore, CPT code 31579, which is frequently used in ENT billing, requires our attention. Let’s begin.
CPT Code 31579 – Description
CPT code 31579 is an ENT procedural code maintained by the American Medical Association under the range – Endoscopy Procedures on the Larynx.
It refers to a medical procedure, “Laryngoscopy with stroboscopy,” which examines the vocal cords and larynx (voice box) using a rigid or flexible laryngoscope. A stroboscope, an instrument that produces repetitive flashes of bright light to illuminate and vibrate the vocal folds, evaluates the function and structure of the voice box.
Hence, these tests are used to identify and assess diseases that impact the vocal cords and larynx, including tumors, polyps, nodules, and voice disorders. Finding any anomalies, figuring out the source of symptoms, and directing treatment strategies are the main objectives of the procedure represented by CPT code 31579.
Scenarios Where CPT Code 31579 is Applicable
You can read the following scenarios for further understanding of CPT code 31579’s correct application.
Laryngeal Cancer or Pre-Cancerous Lesions
Let’s suppose a 60-year-old man who has been a chain smoker since his teenage years comes to your practice for a severe throat ache and difficulty swallowing food. He further complains of symptoms like feeling that there is a lump inside his throat. After looking at his history of smoking, you decide to perform a laryngoscopy with stroboscopy to detect abnormalities like tumors. So, in this case, you can use CPT code 31579 to collect reimbursement for your services.
Voice Hoarseness
Consider a 50-year-old male vocalist who has been complaining of hoarseness for the last five weeks and goes to the ENT clinic. He claims that for the past week, he has been unable to speak. When he does speak, his voice sounds breathy or raspy. The physician performs a flexible laryngoscopy with stroboscopy to evaluate the vibratory function of the patient’s vocal folds in light of the persistent hoarseness and his occupation as a voice-dependent worker. Hence, CPT code 31579 is reported for billing.
Laryngitis
Lastly, imagine a 36-year-old male visits the ENT clinic with complaints of ongoing hoarseness, throat discomfort, and occasional dry cough for the past four weeks. He further mentions that he used to be an alcoholic and smoker with a history of sinusitis. The physician decides to perform a flexible laryngoscopy with stroboscopy to confirm a diagnosis of chronic laryngitis. Therefore, he can bill his services under CPT code 31579.
Applicable Modifiers for CPT Code 31579
Modifiers are used to provide supplemental information regarding a procedure. The insurance payers often adjust the final reimbursement amount based on these two-digit codes. A few modifiers that are typically appended to CPT code 31579 are as follows:
Modifier 22
Modifier 22 refers to increased procedural services. Suppose the laryngoscopy took more time and relatively more effort than usual due to anatomical complexity. In this case, the provider can apply modifier 22 with CPT code 31579 to indicate these increased services and collect the rightful reimbursement.
Modifier 52
On the contrary, modifier 52 refers to reduced services. It refers to the fact that the services were performed partially or terminated at the physician’s discretion. You can apply modifier 52 with CPT code 31579 if you discontinued the procedure due to complications or health risks. However, be mindful that this modifier may result in reduced reimbursement.
CPT Code 31579 – Billing & Reimbursement Guidelines
Now, let’s explore some specific reimbursement guidelines for CPT code 31579. These will help you avoid coding and billing errors that often trigger claim denials.
Meet the Documentation Requirements
Supporting documentation helps the insurance payers identify the services rendered by a healthcare provider and their medical necessity. Therefore, your paperwork must give a comprehensive picture of every service you provided to a patient.
Is there any specific requirement for CPT code 31579? Yes, your clinical documentation for this CPT code should contain the following essential components:
- The reason for laryngoscopy with stroboscopy (e.g., voice change, voice loss, throat ache, difficulty swallowing, etc.)
- The tool used (a flexible or stiff laryngoscope)
- An explanation of the stroboscopic light configurations and capture
- An explanation of the diagnostic process
- Comprehensive results (symmetry, lesions, mucosal wave)
- Conclusion and interpretation
- Plan of care
Bill Once Per Session
You can bill CPT code 31579 once per patient encounter or session, regardless of how many times the procedure is carried out or views are taken during a session. Additionally, since the physician will only bill for the test once, even if it is repeated, this prevents the provider from using modifier 76.
Provide Photos or Videos (if requested)
This is the confusion among many ENT specialists – whether or not they need to include images or videos to support their flexible or rigid laryngoscopy with stroboscopy reports. However, the answer is that unless the insurance payer requests it as a special condition, you are not obligated to give them images or videos to receive payment.
Conclusion
In conclusion, flexible or rigid laryngoscopy with stroboscopy is a specialized examination of the vocal box, or larynx. The procedure detects and evaluates cancers, polyps, nodules, and voice issues that affect the vocal cords and larynx. All of the procedure’s coding information, including the code’s correct application, relevant modifiers, and specific instructions, has been covered in this blog.
After reading this comprehensive guide, are you now fully aware of the billing guidelines and the correct use of CPT code 31579? Otherwise, you could collaborate with a professional ENT billing services provider who can assist you in resolving all your coding concerns.
