Summary & Overview
CPT 31545: Direct Laryngoscopy with Vocal Cord Lesion Excision and Flap
CPT code 31545 represents direct laryngoscopy with excision of vocal cord lesion(s) under microscopic or telescopic visualization, including creation and transfer of a tissue flap to reconstruct the vocal fold. This code captures a specialized otolaryngology procedure combining diagnostic visualization, lesion removal, and reconstructive techniques that preserve or restore phonatory function. Nationally, accurate use of this code matters for appropriate surgical case classification, quality measurement of voice-restorative procedures, and payer adjudication of ENT surgical claims.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when CPT code 31545 is used, common sites of service, and what the code encompasses procedurally. The publication outlines payer coverage considerations and benchmarking where available, highlights coding nuances relevant to operative laryngology, and summarizes policy or billing updates affecting surgical laryngeal services. Clinical stakeholders, coding professionals, and policy analysts will gain clarity on the code’s scope, typical clinical indications, and the workflow implications for surgical scheduling and claims submission.
Data not available in the input is noted where payer-specific policies, associated taxonomies, ICD-10 diagnoses, and related codes would normally appear.
Billing Code Overview
CPT code 31545 describes direct laryngoscopy with excision of vocal cord lesion(s) using a laryngoscope and an operating microscope or telescope, including creation and transfer of a tissue flap over the vocal fold. This procedure is an operative, diagnostic, and therapeutic ENT procedure directed at identifying and removing one or more lesions of the larynx (voice box) and reconstructing the vocal fold with a tissue flap.
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Service type: Surgical excision and microreconstructive laryngeal procedure
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Typical site of service: Operating room or ambulatory surgical center with intraoperative microscopy/telescopic visualization
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient presents to an otolaryngology clinic with progressive hoarseness and vocal fatigue of several months' duration. Video stroboscopy demonstrates a unilateral benign-appearing lesion on the vocal fold consistent with a vocal cord polyp or epithelial lesion. Conservative therapy, including voice therapy and proton pump inhibitor trial for suspected laryngopharyngeal reflux, has failed. The surgeon schedules a direct laryngoscopy with microlaryngoscopy under general anesthesia using a laryngoscope and operating microscope. Intraoperatively, the surgeon inspects the larynx, identifies one or more vocal fold lesions, elevates a mucosal flap, excises the lesions with microinstruments, and repositions a mucosal flap over the vocal fold to preserve vibratory function. Typical workflow: preoperative evaluation and consent in clinic, preoperative anesthesia assessment, operating room direct laryngoscopy and microlaryngoscopy with excision and flap reconstruction, immediate postoperative voice rest instructions, and follow-up with laryngoscopic exam and voice therapy as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the procedure required substantially greater work or time than typical (document increased complexity). |
23 |