MSL with Lysis of Stenosis and Steroid Injection

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Question:  

I am going to do a procedure on a patient with tracheolaryngeal stenosis – a microlaryngoscopy with lysis of the stenosis using a laser and excision of granulation tissue followed by a steroid injection. I gave my surgery scheduler two CPT codes to precertify: 31541 and 31571. She is telling me that I can’t bill these two codes together. Can you please help?

Answer:

Sure – be happy to. Let’s look at the code descriptions:

CityDateCityDate
Dallas, TXJan 20-23Chicago, ILApril 28-30
Las Vegas, NVFeb 11-13Nashville, TNAug 10-13
Orlando, FLApril 15-16Chicago, ILNov 10-12

First, 31541 does not describe lysis of stenosis and/or excision of granulation tissue rather it describes excision of a tumor and/or stripping of vocal cords. Unfortunately, there is no CPT code for microsuspension laryngoscopy (MSL) with lysis of tracheolaryngeal stenosis. Therefore, you’ll have to use an unlisted code, 31599 (Unlisted procedure, larynx) for this procedure. You can use 31541 as your comparison code if you think the procedures are similar.

Then, yes, you may also report 31571 for the MSL with steroid injection assuming you clearly document the separate medical necessity for the procedure in the operative report (e.g., to prevent recurrence of granulation tissue).