Clinical Indicators
Laryngoscopy/Nasopharyngoscopy

Procedure CPT FUD
(Diagnosis must be appropriate for the procedure)
Laryngoscopy, flexible fiberoptic; diagnostic* 31575 0
Laryngoscopy, flexible fiberoptic; with biopsy 31576 0
Laryngoscopy, flexible fiberoptic; with removal of     foreign body 31577 0
Laryngoscopy, flexible fiberoptic; with removal of     lesion 31578 0
Laryngoscopy, flexible or rigid fiberoptic; with     stroboscopy 31579 0
Nasopharyngoscopy with endoscope (separate     procedure) 92511 0

Indications

1. History...one required

a) Persistent hoarseness.
b) Suspected neoplasm.
c) Chronic cough.
d) Chronic postnasal drainage.
e) Recurrent epistaxis.
f) Chronic rhinorrhea.
g) Chronic nasal congestion or obstruction.
h) Hemoptysis.
i) Hemorrhage from throat.
j) Throat pain.
k) Otalgia.
l) Airway obstruction.
m) Dyspnea.
n) Stridor.
o) . Dysphagia
p) Head or neck masses—unknown primary tumor.
q) Laryngeal injury—with hoarseness or airway obstruction.
r) Chronic aspiration.
s) Velopharyngeal incompetence.
t) Suspected foreign body.
u) Recurrent serous otitis media in an adult.
v) History of tobacco use.
w) Obstructive sleep apnea or severe snoring.
x) History of thyroid disorders.
y) Anosmia/Hyposmia.
z) Headaches or facial pain.

2. Physical Examination...one or more required

a) Inadequate complete ENT exam (including mirror exam).
b) Description of breathing and voice.

3. Tests..optional, unless required by diagnosis

a) CT scan of neck including nasopharynx; may include paranasal sinuses, orbit or skull base.
b) Barium swallow or Cine esophagram.
c) Chest x-ray.

Post Examination Observations

1. Bleeding from nose or mouth or emesis of fresh blood; notify surgeon.
2. Pain.
3. Dyspnea.

Outcome Review

1. Immediately
a) Complications noted, if any.
b) Findings of examination.
c) Documentation of procedure.

Associated ICD-9 Diagnostic Codes (included but not limited to):

141.0 Carcinoma base of tongue
141.1 Carcinoma dorsal surface of tongue (not BOT)
141.2 Carcinoma tip & lateral border of tongue
141.3 Carcinoma ventral surface of tongue
141.4 Carcinoma anterior 2/3 of tongue, NOS
141.5 Carcinoma junctional zone of tongue
141.6 Carcinoma lingual tonsil
141.8 Carcinoma tongue, other sites
141.9 Carcinoma tongue, NOS
145.2 Carcinoma hard palate
145.3 Carcinoma soft palate
145.4 Carcinoma uvula
145.6 Carcinoma retromolar trigone
145.8 Carcinoma, oral cavity, other sites, overlapping
145.9 Carcinoma, oral cavity, NOS
146.0 Carcinoma tonsil
146.1 Carcinoma tonsillar fossa
146.2 Carcinoma tonsillar pillars
146.3 Carcinoma vallecula
146.4 Carcinoma epiglottis (free edge), A-E folds
146.5 Carcinoma junctional region (A-E folds & pharyngoepiglottic fold)
146.6 Carcinoma lateral wall oropharynx
146.7 Carcinoma oropharynx, other sites, overlapping
146.8 Carcinoma posterior wall oropharynx
146.9 Carcinoma oropharynx, NOS
147.0 Carcinoma superior wall, nasopharynx
147.1 Carcinoma posterior wall, nasopharynx
147.2 Carcinoma lateral wall, nasopharynx
147.3 Carcinoma anterior wall, nasopharynx
147.8 Carcinoma nasopharynx, other sites, overlapping
147.9 Carcinoma nasopharynx, NOS
148.0 Carcinoma hypopharynx, postcricoid region
148.1 Carcinoma pyriform sinus
148.2 Carcinoma A-E fold, hypopharyngeal aspect
148.3 Carcinoma posterior hypopharyngeal wall
148.8 Carcinoma hypopharynx, other sites, overlapping
148.9 Carcinoma hypopharynx, NOS
149.0 Carcinoma pharynx, NOS
149.1 Carcinoma Waldeyer's ring
149.8 Carcinoma lips, oral cavity, and pharynx, NOS
150.0 Carcinoma cervical esophagus
160.0 Carcinoma nasal cavity
160.1 Carcinoma auditory tube, middle ear, mastoid
160.2 Carcinoma maxillary sinus
160.3 Carcinoma ethmoid sinus
160.4 Carcinoma frontal sinus
160.5 Carcinoma sphenoid sinus Associated ICD-9 Codes
160.8 Carcinoma sinuses, other sites, overlapping
160.9 Carcinoma sinuses, NOS
161.0 Carcinoma glottic larynx
161.1 Carcinoma supraglottic larynx
161.2 Carcinoma subglottic larynx
161.3 Carcinoma laryngeal cartilages
161.8 Carcinoma larynx, other sites, overlapping
161.9 Carcinoma larynx, NOS
162.0 Carcinoma trachea
172 Malignant melanoma
193 Malignant neoplasm of thyroid gland
194.1 Malignant neoplasm of parathyroid gland
196.0 Malignancy of lymph nodes, head & neck
199.1 Malignant neoplasm, unspecified site
210.1 Benign neoplasm of tongue
210.4 Benign neoplasm of mouth, unspecified
210.6 Benign neoplasm of oropharynx
210.7 Benign neoplasm of nasopharynx
210.8 Benign neoplasm of hypopharynx
210.9 Benign neoplasm of pharynx, unspecified
211.0 Benign neoplasm of esophagus
212.0 Benign neoplasm of nasal cavity, middle ear & sinuses
212.1 Laryngeal papillomatosis
212.2 Benign neoplasm of trachea
226 Benign neoplasm of thyroid
230.0 Carcinoma in-situ oral cavity, lip, pharynx
231.0 Carcinoma in-situ, larynx
231.1 Carcinoma in-situ, trachea
231.8 Carcinoma in-situ, nasal, sinus
235.1 Neoplasm of uncertain behavior, lip, oral cavity, pharynx
235.6 Neoplasm of uncertain behavior, larynx
237.3 Paraganglioma
238.1 Neoplasm of uncertain behavior, connective & other soft tissues
240.0 Goiter, specified as simple
240.9 Goiter, unspecified
241.0 Nontoxic uninodular goiter
241.1 Nontoxic multinodular goiter
241.9 Unspecified nontoxic nodular goiter
242.0 Toxic diffuse goiter
242.1 Toxic uninodular goiter
242.2 Toxic multinodular goiter
242.2 Toxic nodular goiter, unspecified
307.0 Stuttering
349.8 CSF rhinorrhea
350.2 Atypical facial pain
352.0 Disorders of olfaction
381.1 Chronic otitis media
381.2 Chronic mucoid otitis media
381.5 Eustachian salpingitis
381.6 Eustachian tube obstruction
385.1 Adhesive middle ear disease
462 Sore throat, acute pharyngitis
464.0 Acute laryngitis
464.1 Acute tracheitis
464.2 Acute laryngotracheitis
464.2 Acute laryngotracheitis with obstruction
464.3 Acute epiglottitis
464.3 Acute epiglottitis with obstruction
464.4 Croup
471.1 Nasal polyposis
472.2 Chronic rhinitis
472.1 Chronic pharyngitis
472.2 Chronic nasopharyngitis
473.0 Chronic maxillary sinusitis
473.1 Chronic frontal sinusitis
473.2 Chronic ethmoidal sinusitis
473.3 Chronic sphenoidal sinusitis
473.8 Chronic pansinusitis
473.9 Chronic sinusitis
474.0 Recurrent or chronic tonsillitis
474.1 Hypertrophic tonsils/adenoids
474.1 Hypertrophic tonsils
474.1 Hypertrophic adenoids
474.8 Chronic tonsil/adenoid conditions— calculus, cicatrix, ulcer, tags
476.0 Chronic laryngitis
476.1 Chronic laryngotracheitis
478.1 Other diseases of nasal cavity & sinuses
478.21 Cellulitis of pharynx or nasopharynx
478.22 Parapharyngeal abscess
478.24 Retropharyngeal abscess
478.25 Edema of pharynx or nasopharynx
478.26 Cyst of pharynx or nasopharynx
478.29 Nasopharyngeal stenosis or abscess
478.31 Unilateral vocal cord/laryngeal paresis
478.32 Unilateral vocal cord/laryngeal paralysis
478.33 Bilateral vocal cord/laryngeal paresis
478.34 Bilateral vocal cord/laryngeal paralysis
478.4 Laryngeal/vocal cord polyp
478.5 Other diseases of vocal cords (nodules, leukoplakia, granuloma, abscess)
478.6 Edema of larynx
478.71 Cellulitis & perichondritis of larynx
478.74 Subglottic/laryngeal stenosis
478.75 Laryngeal spasm
478.8 Upper respiratory tract hypersensitivity reaction
518.81 Respiratory failure
528.3 Cellulitis and abscess, oral cavity
530.11 Reflux esophagitis
530.3 Stricture & stenosis of esophagus
530.82 Esophageal hemorrhage
530.84 Tracheoesophageal fistula
710.3 Dermatomyositis
714 Rheumatoid arthritis
729.8 Foreign body
748.0 Choanal atresia
748.2 Laryngeal web
748.3 Laryngotracheal anomalies, other (e.g., laryngomalacia, tracheomalacia, laryngocoele, clefts, congenital stenosis)
750.27 Pharyngeal diverticulum
750.29 Velopharyngeal incompetence
750.3 Tracheoesophageal fistula, esophageal atresia and stenosis
780.53 Obstructive sleep apnea
781.1 Disturbances of taste and smell
784.0 Headache
784.1 Throat pain (odynophagia)
784.2 Mass, head or neck
784.41 Aphonia
784.49 Hoarseness—unspecified
784.5 Dysarthria, dysphasia, slurred speech
784.7 Epistaxis
784.8 Hemorrhage from throat
784.9 Choking, sneezing, halitosis, mouth breathing
786.1 Stridor
786.2 Cough
786.3 Hemoptysis
787.2 Dysphagia
933.0 Foreign body, pharynx
933.1 Foreign body, larynx
935.1 Foreign body, esophagus
V10.9 History of malignant neoplasm
V15.82 History of tobacco use

Additional Information
Assistant Surgeon—N
Supply Charges—N
Prior Approval—N
* If appropriate, a "-25" modifier must be added to the E & M visit code if this procedure is performed on the same date as the office visit.

Patient Information
Fiberoptic laryngoscopy and nasopharyngoscopy are diagnostic procedures using a fiberoptic endoscope. The endoscope is attached to a bright light to look into the nasal passages and back of the throat as far down as the voice box. The instrument is usually passed through the nose after a nasal spray is used to shrink and numb the nasal membranes. This frequently performed examination allows for a more thorough look at the nose, mouth and throat in order to diagnose problems that are otherwise difficult to visualize. Complications associated with this examination are rare and include temporary sneezing, coughing, gagging, and bleeding.

Important Notice

The Clinical Indicators for Otolaryngology--Head and Neck Surgery are guidelines only. In no sense do they represent a standard of care. The applicability of an indicator for a procedure, and/or of the process or outcome criteria, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these guidelines will not ensure successful treatment in every situation. The American Academy of Otolaryngology-Head and Neck Surgery, Inc. emphasizes that these clinical indicators should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results.

© 2000 American Academy of Otolaryngology-Head and Neck Surgery. One Prince Street, Alexandria, VA 22314.