Leisha Fleming asked:
Would anyone explain the cpt guideline for the following:
Surgery/Respiratory system/Larynx/Endoscopy \- all paired structures contained within one side of the larynx/pharynx are considered unilateral.
Procedure to excise mass on left side of vocal cord does not need a Lt modifier or if excised from both sides there is no mod50? Not clear on unilateral.
Also; 31540 states procedure on cords plural. But 31545 states cord singular. why the difference?
Thanks!
Answer:
### Surgical Procedures on the Larynx
#### Endoscopy Procedures on the Larynx
Laryngoscopy; direct; operative; with excision of tumor and/or stripping of vocal cords or epiglottis
**[31540](http://www.findacode.com/code.php?set=CPT&c=31540) Laryngoscopy; direct; operative; with excision of tumor and/or stripping of vocal cords or epiglottis;**
**[31541](http://www.findacode.com/code.php?set=CPT&c=31541) with operating microscope or telescope**
Laryngoscopy; direct; operative; with operating microscope or telescope; with submucosal removal of non-neoplastic lesion(s) of vocal cord
**[31545](http://www.findacode.com/code.php?set=CPT&c=31545) _reconstruction_ with local tissue flap(s)**
**[31546](http://www.findacode.com/code.php?set=CPT&c=31546) _reconstruction_ with graft(s) (includes obtaining autograft)**
**31540** - Laryngoscopy; direct; operative; with excision of tumor and/or stripping of vocal cords or epiglottis;
A direct laryngoscope allows the physician to visualize structures directly using fiberoptics. There are two types of direct scopes; a rigid angled scope and a flexible scope. A rigid scope is the one most often used in surgery and inserted through the mouth under a general anesthetic. The oral cavity; oropharynx; hypopharynx; larynx; and trachea are examined with the direct laryngoscope. The tumor is located and excised along with a margin of healthy tissue. Alternatively; lesions on the vocal cords or epiglottis may be removed by stripping away the superficial tissue. An operating microscope and/or telescope may also be used during the procedure to allow better visualization and evaluation of the tumors or lesions and to allow more meticulous dissection of tissues. _Use [31540](https://www.findacode.com/code.php?set=CPT&c=31540) when the procedure is performed without the use of an operating microscope or telescope_ and [31541](https://www.findacode.com/code.php?set=CPT&c=31541) when
an operating microscope and/or telescope are used.
**31545** - Laryngoscopy; direct; operative; with operating microscope or telescope; with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with local tissue flap(s)
A direct laryngoscope allows the physician to visualize structures directly using fiberoptics. There are two types of direct scopes; a rigid angled scope and a flexible scope. A rigid scope is the one most often used in surgery and inserted through the mouth under a general anesthetic. The oral cavity; oropharynx; hypopharynx; and trachea are examined with the direct laryngoscope. The vocal cords are visualized and the laryngoscope is suspended. An operating microscope and/or telescope are used to examine the lesion and determine its extent. A micro-knife and/or micro-scissors are used to incise the vocal cord tissue. Blunt and sharp dissection is used to separate and remove the lesion from surrounding healthy tissue. _In [31545](https://www.findacode.com/code.php?set=CPT&c=31545); the surgical defect is closed using a local tissue flap. A tissue flap is developed; trimmed and advanced or rotated over the surgical defect. The flap is secured with sutures._ In
[31546](https://www.findacode.com/code.php?set=CPT&c=31546); the lesion involves deeper tissues and an autograft is used to reconstruct the soft tissue defect resulting from the removal of the lesion. A tissue graft such as fat is harvested from a remote site and prepared for transfer to soft tissue defect. The graft is placed beneath a mucosal flap; which is secured with sutures.
Now why do you not code for laterally? Well it is the structure of the vocal cords.
**31540** - Laryngoscopy; direct; operative; with excision of tumor and/or stripping of **__vocal cords_ _**or epiglottis;
So vocal CORDS plural is used in the description so even though you might do the lf or rt they tell you not to use the liberality. Unlike code
**31545** - Laryngoscopy; direct; operative; with operating microscope or telescope; with submucosal removal of non-neoplastic lesion(s) of __**vocal cord**__; reconstruction with local tissue flap(s)
One cord!
Hope this helps you out.
Would anyone explain the cpt guideline for the following:
Surgery/Respiratory system/Larynx/Endoscopy \- all paired structures contained within one side of the larynx/pharynx are considered unilateral.
Procedure to excise mass on left side of vocal cord does not need a Lt modifier or if excised from both sides there is no mod50? Not clear on unilateral.
Also; 31540 states procedure on cords plural. But 31545 states cord singular. why the difference?
Thanks!
Answer:
### Surgical Procedures on the Larynx
#### Endoscopy Procedures on the Larynx
Laryngoscopy; direct; operative; with excision of tumor and/or stripping of vocal cords or epiglottis
**[31540](http://www.findacode.com/code.php?set=CPT&c=31540) Laryngoscopy; direct; operative; with excision of tumor and/or stripping of vocal cords or epiglottis;**
**[31541](http://www.findacode.com/code.php?set=CPT&c=31541) with operating microscope or telescope**
Laryngoscopy; direct; operative; with operating microscope or telescope; with submucosal removal of non-neoplastic lesion(s) of vocal cord
**[31545](http://www.findacode.com/code.php?set=CPT&c=31545) _reconstruction_ with local tissue flap(s)**
**[31546](http://www.findacode.com/code.php?set=CPT&c=31546) _reconstruction_ with graft(s) (includes obtaining autograft)**
**31540** - Laryngoscopy; direct; operative; with excision of tumor and/or stripping of vocal cords or epiglottis;
A direct laryngoscope allows the physician to visualize structures directly using fiberoptics. There are two types of direct scopes; a rigid angled scope and a flexible scope. A rigid scope is the one most often used in surgery and inserted through the mouth under a general anesthetic. The oral cavity; oropharynx; hypopharynx; larynx; and trachea are examined with the direct laryngoscope. The tumor is located and excised along with a margin of healthy tissue. Alternatively; lesions on the vocal cords or epiglottis may be removed by stripping away the superficial tissue. An operating microscope and/or telescope may also be used during the procedure to allow better visualization and evaluation of the tumors or lesions and to allow more meticulous dissection of tissues. _Use [31540](https://www.findacode.com/code.php?set=CPT&c=31540) when the procedure is performed without the use of an operating microscope or telescope_ and [31541](https://www.findacode.com/code.php?set=CPT&c=31541) when
an operating microscope and/or telescope are used.
**31545** - Laryngoscopy; direct; operative; with operating microscope or telescope; with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with local tissue flap(s)
A direct laryngoscope allows the physician to visualize structures directly using fiberoptics. There are two types of direct scopes; a rigid angled scope and a flexible scope. A rigid scope is the one most often used in surgery and inserted through the mouth under a general anesthetic. The oral cavity; oropharynx; hypopharynx; and trachea are examined with the direct laryngoscope. The vocal cords are visualized and the laryngoscope is suspended. An operating microscope and/or telescope are used to examine the lesion and determine its extent. A micro-knife and/or micro-scissors are used to incise the vocal cord tissue. Blunt and sharp dissection is used to separate and remove the lesion from surrounding healthy tissue. _In [31545](https://www.findacode.com/code.php?set=CPT&c=31545); the surgical defect is closed using a local tissue flap. A tissue flap is developed; trimmed and advanced or rotated over the surgical defect. The flap is secured with sutures._ In
[31546](https://www.findacode.com/code.php?set=CPT&c=31546); the lesion involves deeper tissues and an autograft is used to reconstruct the soft tissue defect resulting from the removal of the lesion. A tissue graft such as fat is harvested from a remote site and prepared for transfer to soft tissue defect. The graft is placed beneath a mucosal flap; which is secured with sutures.
Now why do you not code for laterally? Well it is the structure of the vocal cords.
**31540** - Laryngoscopy; direct; operative; with excision of tumor and/or stripping of **__vocal cords_ _**or epiglottis;
So vocal CORDS plural is used in the description so even though you might do the lf or rt they tell you not to use the liberality. Unlike code
**31545** - Laryngoscopy; direct; operative; with operating microscope or telescope; with submucosal removal of non-neoplastic lesion(s) of __**vocal cord**__; reconstruction with local tissue flap(s)
One cord!
Hope this helps you out.
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