If you look in the CPT manual, you have many options for coding laryngoscopies based on the “type” of laryngoscopy performed. Can you tell the difference between a flexible, indirect, and direct laryngoscopy?
A flexible laryngoscopy uses a thin flexible tube to examine the larynx. The operative report often uses the “word” flexible when describing this type of laryngoscopy, but the term “fiber optic laryngoscope” can be another good clue that you are looking at a flexible laryngoscopy since the fiberoptic scope is a flexible scope. Flexible laryngoscopies are oftenperformed in a hospital at the patient’s bedside or in a doctor’s office.
An indirect laryngoscopy involves the use of a mirror to indirectly see and examine the larynx. The physician places the mirror towards the back of the throat and shines a light onto the mirror’s surface which allows him to indirectly see the structures of the throat and the larynx. This type of exam is typically performed in a doctor’s office.
A direct laryngoscopy involves the use of a “rigid” scope to examine the larynx. The physician passes the scope into the mouth and down into the larynx to directly visualize the structures of the larynx through the scope. This type of laryngoscopy is performed under anesthesia in an operating/procedure room. This type of laryngoscopy may also involve the use of an operating microscope or telescope in conjunction with the scope to magnify the structures being examined. The report may directly state that an operative microscope or telescope was used or may list a type of microscope or telescope. A “0 degree Hopkins rod” for example is a very common type of telescope used during laryngoscopy so if you see this term used in an operative report you should be looking for a laryngoscopy code “with operative microscope or telescope” in the code description.
Knowing the difference between these three types of laryngoscopies, the setting in which these procedures are typically performed, and some common “keys” to look for in the operative report can help you locate the right code quickly.
