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Official Description

Laryngoscopy, flexible; with therapeutic injection(s) (eg, chemodenervation agent or corticosteroid, injected percutaneous, transoral, or via endoscope channel), unilateral

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 31573 involves the use of a flexible laryngoscope to perform a therapeutic injection into a unilateral vocal fold. This procedure is primarily aimed at addressing various vocal cord issues, such as reducing scarring, edema, or muscle spasms that may affect vocal function. The injection can also serve as an augmentation technique to treat conditions like unilateral vocal cord paralysis or bowing, which can result from muscle atrophy, paresis, or age-related changes in the larynx, known as presbylaryngis. The materials used for injection can vary and may include corticosteroids, chemodenervation agents like botulinum toxin, and other substances such as gelfoam, collagen, micronized AlloDerm, Teflon, and calcium hydroxyapatite. The procedure typically begins with the application of a topical anesthetic to ensure patient comfort, followed by the careful insertion of the laryngoscope through the nasal passage to visualize the larynx and vocal cords. Depending on the approach—transoral, percutaneous, or endoscopic—the injection is administered under direct visualization to ensure precision and effectiveness. This procedure is crucial for patients experiencing vocal cord dysfunction, as it can significantly improve their vocal quality and overall quality of life.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 31573 is indicated for various conditions affecting the vocal cords. These include:

  • Vocal Cord Scarring - The procedure may be performed to reduce scarring on the vocal cords, which can impair voice quality.
  • Vocal Cord Edema - Therapeutic injections can help alleviate swelling in the vocal cords, improving vocal function.
  • Muscle Spasms - The injection of chemodenervation agents can be utilized to treat involuntary muscle spasms affecting the vocal cords.
  • Unilateral Vocal Cord Paralysis - Augmentation techniques may be indicated for patients with paralysis of one vocal cord, helping to restore voice function.
  • Vocal Cord Bowing - This condition, often resulting from muscle atrophy or age-related changes, can be treated through injection to improve vocal fold closure.

2. Procedure

The procedure involves several detailed steps to ensure effective therapeutic injection into the vocal fold. The following outlines the procedural steps:

  • Step 1: Anesthesia Application - A topical anesthetic is first instilled into the nasal cavity, palate, and posterior pharynx to minimize discomfort during the procedure. This anesthetic is also dripped onto the base of the tongue and larynx using fiberoptic guidance.
  • Step 2: Initial Laryngoscope Insertion - A flexible laryngoscope is introduced through the nose and advanced into the pharynx until the larynx and vocal cords are visualized. This allows the physician to assess the area before the injection.
  • Step 3: Additional Anesthesia for Percutaneous Injection - If a percutaneous injection is planned, the skin and deep tissue over the thyroid area are anesthetized to ensure patient comfort during needle insertion.
  • Step 4: Injection Technique - Depending on the approach, the injection is performed as follows:
    • Transoral Approach - The needle is advanced through the mouth to the larynx/vocal cord, and the selected material is injected under endoscopic visualization before removing the needle.
    • Endoscopic Injection - The needle is advanced through a working channel in the endoscope, allowing for direct injection into the vocal cord while visualizing the procedure.
    • Percutaneous Approach - A needle is inserted through the thyroid cartilage and thyrohyoid membrane, angled to reach the vocal cord, and the selected material is injected under endoscopic visualization before the needle is removed.
  • Step 5: Completion of the Procedure - After the injection is completed, the flexible laryngoscope is carefully removed from the patient's nasal passage.

3. Post-Procedure

Post-procedure care following the injection involves monitoring the patient for any immediate adverse reactions to the injected material. Patients may be advised to avoid strenuous vocal activities for a specified period to allow for optimal healing and effectiveness of the injection. Follow-up appointments may be scheduled to assess the outcome of the procedure and determine if additional treatments are necessary. It is essential for patients to report any unusual symptoms or complications to their healthcare provider promptly.

Short Descr LARGSC W/THER INJECTION
Medium Descr LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI
Long Descr Laryngoscopy, flexible; with therapeutic injection(s) (eg, chemodenervation agent or corticosteroid, injected percutaneous, transoral, or via endoscope channel), unilateral
Status Code Active Code
Global Days 000 - Endoscopic or Minor Procedure
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 3 - Special payment adjustment rules for multiple endoscopic procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Endoscopic Base Code 31575  Laryngoscopy, flexible; diagnostic
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P8H - Endoscopy - laryngoscopy
MUE 1
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
GC This service has been performed in part by a resident under the direction of a teaching physician
LT Left side (used to identify procedures performed on the left side of the body)
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
CR Catastrophe/disaster related
FS Split (or shared) evaluation and management visit
GA Waiver of liability statement issued as required by payer policy, individual case
GZ Item or service expected to be denied as not reasonable and necessary
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
RT Right side (used to identify procedures performed on the right side of the body)
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
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2017-01-01 Added Added
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