Summary & Overview
CPT 31400: External Arytenoidectomy or Arytenoidopexy
CPT code 31400 covers external arytenoidectomy or arytenoidopexy—open surgical procedures that excise or affix the arytenoid cartilage to improve airway function in patients with vocal cord paralysis. Nationally, these procedures are part of the surgical laryngology repertoire for restoring breathing and reducing stridor when less invasive approaches are unsuitable. The code is relevant to hospital-based otolaryngology practices, ambulatory surgical centers, and payers that manage surgical airway care.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service settings, coverage and billing considerations across major payers, typical modifiers and procedural coding nuances, and related policy and reimbursement themes. The publication summarizes where CPT code 31400 fits within surgical airway care, outlines common payment and documentation drivers, and flags areas where coding clarity or payer policy differences commonly arise.
Intended for coding professionals, surgical practices, and payer policy analysts, this piece provides actionable reference material on clinical indications, typical sites of service, and the billing landscape for external arytenoid procedures under CPT code 31400.
Billing Code Overview
CPT code 31400 describes an external arytenoidectomy or arytenoidopexy. The provider performs an arytenoidectomy (excision of the arytenoid cartilage) or an arytenoidopexy (surgical fixation of the arytenoid cartilage or muscles) using an external surgical approach rather than an endoscopic technique. These procedures are typically performed to improve airway patency in patients with vocal cord paralysis or significant arytenoid dysfunction.
Service type: Surgical airway procedure (open/external laryngeal surgery)
Typical site of service: Operating room or ambulatory surgical center
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with unilateral vocal cord paralysis causing significant inspiratory airway obstruction and exertional dyspnea. The patient presents to an otolaryngology clinic after progressive shortness of breath and noisy breathing; prior evaluation includes laryngoscopy confirming immobile vocal cord(s) with persistent posterior glottic airway compromise. Nonoperative management (voice therapy, observation) was insufficient, and the surgeon elects an external approach to perform an arytenoidectomy or arytenoidopexy to widen the posterior glottis and improve airway patency.
Preoperative workflow includes history and physical, complete head and neck exam, flexible laryngoscopy or stroboscopy, pulmonary assessment as indicated, informed consent discussing risks (airway compromise, aspiration, voice change), and scheduling in an operating room under general anesthesia. Intraoperative care includes direct laryngoscopy for assessment, external neck incision, exposure of the arytenoid cartilage, excision or fixation of the arytenoid as indicated, hemostasis, and staged closure. Postoperative care includes airway monitoring in recovery, swallow and voice assessment, possible short inpatient observation for airway and aspiration risk, and outpatient follow-up with laryngoscopy to document improved glottic airway and voice outcomes.
Coding Specifications
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