Summary & Overview
CPT 31591: Medialization of Displaced or Paralyzed Vocal Cord
CPT code 31591 denotes surgical medialization of a displaced or paralyzed vocal cord to restore laryngeal function for improved breathing, vocalization, and swallowing. Nationally, this code represents a specialized otolaryngology procedure used to treat unilateral vocal fold paralysis or displacement that compromises airway protection and voice. Use of the code is relevant to surgical case mix, perioperative resource planning, and post‑acute voice and swallowing rehabilitation needs.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical context for the procedure, typical sites of service, and the service type. The publication also summarizes payer coverage patterns and coding considerations, benchmark utilization, and relevant policy updates that affect authorization and post‑operative care pathways.
This resource helps clinicians, coding professionals, and policy analysts understand the administrative and clinical dimensions of CPT code 31591, including where the procedure is commonly performed and why accurate coding matters for surgical quality measurement, reimbursement workflow, and patient access.
Billing Code Overview
CPT code 31591 describes a surgical procedure to restore laryngeal function by medializing a displaced or paralyzed vocal cord to improve breathing, voice, and swallowing. This procedure repositions a vocal fold that is displaced to one side back toward the midline to optimize glottic closure and airway protection.
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Service type: Surgical laryngeal reconstruction/medialization of the vocal cord
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Typical site of service: Hospital operating room or ambulatory surgery center where otolaryngology (head and neck) surgical procedures are performed
Clinical & Coding Specifications
Clinical Context
A 62-year-old male presents with progressive hoarseness, weak cough, and occasional aspiration after a left-sided posterior inferior cerebellar artery (PICA) stroke three months earlier. Laryngoscopic examination demonstrates left vocal fold paralysis in the paramedian position with incomplete glottic closure and reduced airway protection. The multidisciplinary workflow begins with an otolaryngology evaluation including flexible laryngoscopy and voice assessment. Following conservative measures (voice therapy, swallow evaluation) and discussion of risks/benefits, the surgeon schedules an operative medialization thyroplasty to restore the paralyzed vocal cord toward the midline to improve phonation and swallowing. On the day of service the patient is admitted to an ambulatory surgery center or hospital operating room (typical sites of service) for regional or general anesthesia. Intraoperative steps include laryngeal exposure, localization of the paraglottic space, creation of a thyroplasty window in the thyroid cartilage, insertion and adjustment of an implant or injection material to medialize the vocal fold, intraoperative voice testing (when possible), hemostasis, and closure. Postoperative workflow includes voice and swallow precautions, outpatient otolaryngology follow-up for stroboscopy or laryngoscopy, and speech pathology for voice rehabilitation. Typical payors for coverage review and prior authorization include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, ongoing postoperative care |