Injection Laryngoplasty: Code Correctly, Collect $1,046

vocal cords

Hi, otolaryngology coders! Have you been enjoying the new code CPT® 2017 gave you for injection laryngoplasty? Today, let’s take a closer look at 31574 (Laryngoscopy, flexible; with injection[s] for augmentation [e.g., percutaneous, transoral], unilateral).

When Will You Use 31574?

Injection laryngoplasty is on the rise among ENTs. The procedure involves injecting an augmenting material into the larynx. The effect is to move the patient’s vocal cords toward the center to improve symptoms in patients with vocal cord paralysis and stenosis. For instance, Aetna “considers injections of bulking agents medically necessary for members with unilateral vocal cord paralysis” and includes these ICD-10 options as covered codes when you meet policy requirements:

  • J38.00-J38.02, Paralysis of vocal cords and larynx
  • J38.3, Other diseases of vocal cords.

Anything to Know From the MPFS?

Any time you’re reporting a new code, you should check out what the Medicare Physician Fee Schedule (MPFS) has to say.

Fees and RVUs: The MPFS assigns 31574 4.30 total facility RVUs, which calculates to a national rate of $154.32 for a physician performing the service in a facility.

The nonfacility rate is more impressive because it takes into account the added expense to your practice when you perform the service in your own office. The 29.16 total nonfacility RVUs add up to a national rate of $1,046.51.

Global days: The global period for 31574 is 000. Here’s the technical definition (be sure to heed the bold section at the end about generally not reporting a same-day E/M): “Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; evaluation and management services on the day of the procedure generally not payable.”

Multiple procedures: Multiple endoscopy rules apply to 31574. The endoscopic base code for 31574 is 31575 (Laryngoscopy, flexible; diagnostic). If you think it’s odd that 31574 has numerically later code 31575 as the base code, keep in mind that 31574 is out of sequence in CPT®. You’ll find 31574 located out of order, just before 31579 (Laryngoscopy, flexible or rigid telescopic, with stroboscopy).

Bilateral bonus: Be sure to catch that the 31574 descriptor specifies unilateral. The MPFS gives the code a bilateral indicator of 1, which means, “150% payment adjustment for bilateral procedures applies. If the code is billed with the bilateral modifier or is reported twice on the same day by any other means (e.g., with RT and LT modifiers, or with a 2 in the units field), base the payment for these codes when reported as bilateral procedures on the lower of: (a) the total actual charge for both sides or (b) 150% of the fee schedule amount for a single code. If the code is reported as a bilateral procedure and is reported with other procedure codes on the same day, apply the bilateral adjustment before applying any multiple procedure rules.”

Remember: The M in MPFS is for Medicare, so you can’t assume these rules apply to private payers. If you have similar fee schedule information from your other payers, be sure to check for any variations you need to know before reporting to them.

How About You?

Have you been using 31574? Are there any other procedure you’d like to see get dedicated codes?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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1 Comments For This Post

  1. Beverly Prudhomme Says:

    This was very helpful but we have a question on the supplies. Our providers perform this in place of service 22 so we would drop a facility charge (not through Part B). The needles for these procedures are pricey but I cannot find a HCPCS code. Usually with CMS if the facility fee is under OPPS/ASC, they bundle all of the supplies unless they let you know the items are non-pass through. Have you seen anything on billing additionally for the needles? Thanks

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