Indirect laryngoscopy is certainly the simplest of the three laryngoscopy types (indirect laryngoscopy, direct laryngoscopy, flexible laryngoscopy). Thus, the five procedures in this category do not include a scope and offer the least reimbursement. Relatively, they are used when the otolaryngologist observes the patient using mirrors to visualize the larynx, which could be either for diagnostic determinations or as a guide meant for biopsy, lesion or foreign body removal, or for vocal cord injection. Go through this expert medical coding article and learn what ICD9 codes as well as CPT codes apply to indirect laryngoscopy.

The easiest of these codes (diagnostic) frequently is used during a routine examination and must not be billed separately.

In case the mirror is used to check on a definite condition or symptom, though, it may be billed distinctly. For instance, a patient visits the doctor owing to an earache (381.01, acute serous otitis media) however also complains of a sore tongue. The otolaryngologist evaluates the tongue using the mirror and defines the patient has glossitis (529.0).

As the mirror exam is not related to the earache, 31505 can be billed distinctly. The suitable level evaluation and management (E/M) service would be coded with a -25 modifier (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) attached. Diagnosis code 381.01 would be connected to the E/M code, however the mirror exam would correspond to diagnosis code 529.0.

However, in case a patient suffering from hoarseness (784.49) already had received a flexible laryngoscopy (31575, laryngoscopy, flexible fiberoptic; diagnostic), and in the course of follow-up the otolaryngologist uses the mirror to examine how the patient is doing, no E/M may be billed. The otolaryngologist can charge, still, for the 31505.

Other services executed via indirect laryngoscopy are:

• 31510( laryngoscopy, indirect; with biopsy)
• 31511 (laryngoscopy, indirect; with removal of foreign body)
• 31512( laryngoscopy, indirect; with removal of lesion)
• 31513 (laryngoscopy, indirect; with vocal cord injection)

Though these diagnostic procedures must not be reported if carried out during the same session as a surgical endoscopy, they might be reported in case an open surgical procedure is accomplished. Furthermore, 31511 may be billed distinctly in case the procedure is carried out during critical care of a patient.

Note (Indirect laryngoscopy with vocal cord injection uses both mirrors and a laryngoscope. The mirrors are used to examine the larynx and visualize the injection, which is then performed by a laryngoscope.)

Key words Once an indirect laryngoscopy has been carried out, coders must look for these key words: indirect and mirror.

An indirect laryngoscopy must be coded 31505. Added words such as biopsy, removal of foreign body or lesion, as well as vocal cord injection must guide the coder to choose either 31510, 31511, 31512 or 31513, as suitable.