AHA Coding Clinic® for HCPCS - 2011 Issue 3; ASK the EDITOR

Laryngoscopic CO2 laser destruction, vocal cord lesions

A patient with persistent hoarseness and gastroesophageal disease presents for laryngoscopy. The patient was brought to the operating room and general endotracheal anesthesia was induced successfully. A laryngoscope was placed transorally and the patient’s tissues were examined. The scope was then withdrawn and the adult ventilating bronchoscope was placed alongside the existing endotracheal tube into the trachea and mainstem bronchus to the takeoff of the segmental bronchi without abnormalities seen. The bronchoscope was withdrawn and an adult esophagoscope was then placed through the upper esophageal sphincter and the entire length of the esophagus was examined. The esophagoscope was withdrawn and a laryngoscope was placed in suspension using Lewy suspension device. The operating microscope was brought into position with CO2 laser attached with settings of 6 watts at 0.25 second increments. The tiny vocal nodules were vaporized effectively. With the laser a small incision was made into the central portion of the left vocal cord polyp and the thickened material within the polyp was removed with a knife and probe. Once this was completed a flap was laid nicely back into position. What CPT codes should we assign for the direct laryngoscopy with CO2 laser destruction of vocal cord lesions with the use of an operating microscope?  ...

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