I was hoping to get some guidance on the below surgical case.
A patient previously underwent a "Single stage laryngotracheal reconstruction with anterior and posterior costal cartilage grafts" in 2019 (CPT 31551).
The patient came back on 7/2022 and underwent a "Laryngoplasty, reduction of posterior graft with CO2 laser"
Because the surgeon was only repairing the graft:
1- Would you use an unlisted code, 31599? (If so, what is a comparable code for pricing?)
2- Would you use 31551? (If so, with modifier 52?)
7/28/2022 Op Report: MLB, Laryngoplasty, reduction of posterior graft with CO2 laser:
Description of Operative Procedure: The patient was brought to the operative suite and placed under general anesthesia. The bed was turned 90 degrees and a tooth guard was put in place. A laryngoscope was used to expose the larynx, and the larynx sprayed with 2% lidocaine. A hopkins rod telescope was inserted through the larynx down to the bilateral mainstem bronchi and photodocumentation obtained with the above listed findings. The telescope was then removed and cleaned.
We then proceeded with reduction of the posterior graft. The CO2 laser with handpiece was obtained and tested. Power was set to 8 W. Wet gauze was placed on the patient's eyes and head was wrapped with wet towels. Laser pause was performed to ensure appropriate O2 levels and eyewear protection. The posterior graft was divided at midline, dividing the mucosa and cartilage graft. This was performed using a combination of the CO2 laser and sickle knife. Approximately 2 mm width of the graft was removed. The cartilaginous edges were smoothed so that a straight edge was achieved. A right angle probe was used to free up the underlying edges of the cartilage graft on each side. There was good mobility of the graft for reduction. A 5-0 PDS suture was used to reapproximate the edges of the split graft using the laproscopic needle driver with the knots buried deep below the mucosal surface. This provided food reapproximation of the graft. Photodocumentation was then performed.
The patient was then awakened and returned to the PICU in good condition. There was minimal blood loss and no complications. Standard operating room protocol and universal precautions were utilized throughout the procedure.
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