Direct Laryngoscopy with Multiple Biopsies

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Question:  

I did 31535 Laryngoscopy, direct, operative, with biopsy but took multiple biopsies through the laryngoscope of the hypopharynx and base of tongue looking for an unknown primary malignancy. Can I report 31535 more than once to account for the multiple biopsies? Can I bill 42802 (Biopsy; hypopharynx) with the direct laryngoscopy? Lastly, what if I did a separate nasopharyngeal biopsy at the same time also looking for an unknown primary malignancy – can I bill separately for the nasopharyngeal biopsy?

Answer:

CPT 31535 includes any number of biopsies obtained through the same surgical exposure as the direct laryngoscopy so it would not be appropriate to also report biopsies from the hypopharynx, vocal cords, arytenoids or the larynx areas. Any biopsies taken via the scope are included in 31536 not 42802 which does not define a biopsy via a laryngoscope. If a biopsy is not taken via the scope, then it may be separately reported using the appropriate biopsy code. Be sure to make this very clear in your operative note. You may separately report a code for the nasopharyngeal biopsy since that procedure is performed through a separate surgical exposure, the nose.