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Official Description

Laryngoscopy, flexible; with injection(s) for augmentation (eg, percutaneous, transoral), unilateral

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 31574 involves a flexible laryngoscopy, which is a minimally invasive technique used to visualize the larynx and vocal cords. This procedure is specifically performed with the intent to inject a therapeutic material into one side (unilateral) of the vocal fold. The primary purpose of this injection is for augmentation, which can address various conditions such as unilateral vocal cord paralysis, vocal cord bowing, or other issues resulting from muscle atrophy, paresis, or age-related changes in the larynx (presbylaryngis). The materials used for injection can vary and may include substances like steroids, botulinum toxin (a chemodenervation agent), gelfoam, collagen, micronized AlloDerm, Teflon, and calcium hydroxyapatite. Before the procedure, a topical anesthetic is applied to the nasal cavity, palate, and posterior pharynx to minimize discomfort. The flexible laryngoscope is then introduced through the nose, allowing for direct visualization of the larynx and vocal cords. Depending on the approach—whether percutaneous or transoral—the injection technique may differ, but all methods aim to deliver the selected material precisely to the vocal fold under endoscopic guidance. This procedure is crucial for patients experiencing voice disorders due to the aforementioned conditions, as it can significantly improve vocal function and quality of life.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 31574 is indicated for various conditions affecting the vocal folds, particularly when therapeutic intervention is required to enhance vocal function. The specific indications include:

  • Unilateral Vocal Cord Paralysis - A condition where one vocal cord is unable to move, leading to voice difficulties.
  • Vocal Cord Bowing - A situation where the vocal cords appear thin or weak, often due to muscle atrophy or aging.
  • Muscle Atrophy - The wasting away of muscle tissue, which can affect the vocal cords and their ability to function properly.
  • Paresis - Partial loss of movement in the vocal cords, which can result in voice changes or difficulties.
  • Presbylaryngis - Age-related changes in the larynx that can lead to voice changes and decreased vocal quality.

2. Procedure

The procedure for CPT® Code 31574 involves several detailed steps to ensure effective injection into the vocal fold. The steps are as follows:

  • Step 1: Anesthesia Application - A topical anesthetic is first instilled into the nasal cavity and onto the palate and posterior pharynx to minimize discomfort during the procedure. This is crucial for patient comfort and cooperation.
  • Step 2: Initial Laryngoscope Insertion - A flexible laryngoscope is introduced through the nose. The anesthetic is dripped onto the base of the tongue and the larynx using fiberoptic guidance to ensure adequate numbing of the area.
  • Step 3: Additional Anesthesia for Percutaneous Injection - If a percutaneous injection is planned, the area over the thyroid in the neck is also anesthetized to numb the skin and deeper tissues, preparing for the injection.
  • Step 4: Visualization of Vocal Cords - After allowing time for the anesthetic to take effect, the flexible laryngoscope with a working channel is reinserted through the nose and advanced into the pharynx until the larynx and vocal cords are clearly visualized.
  • Step 5: Injection Technique - For a transoral approach, a needle is advanced through the mouth to the larynx/vocal cord, and the selected material is injected under endoscopic visualization before the needle is removed. For endoscopic injection, the needle is advanced through the working channel of the endoscope to inject the vocal cord directly. In the percutaneous approach, a needle is inserted through the thyroid cartilage and thyrohyoid membrane, angled to reach the vocal cord, and the material is injected under visualization.
  • Step 6: Completion of Procedure - After the injection is completed, the flexible laryngoscope is carefully removed from the patient's airway.

3. Post-Procedure

Post-procedure care following CPT® Code 31574 typically involves monitoring the patient for any immediate adverse reactions to the injected material. Patients may be advised to rest their voice for a period to allow for optimal healing and to minimize strain on the vocal cords. Follow-up appointments may be scheduled to assess the effectiveness of the injection and to monitor for any complications or changes in vocal function. It is important for patients to report any unusual symptoms, such as difficulty breathing or swallowing, to their healthcare provider promptly.

Short Descr LARGSC W/NJX AUGMENTATION
Medium Descr LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI
Long Descr Laryngoscopy, flexible; with injection(s) for augmentation (eg, percutaneous, transoral), 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).
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
GC This service has been performed in part by a resident under the direction of a teaching physician
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.
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).
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.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
CR Catastrophe/disaster related
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
GW Service not related to the hospice patient's terminal condition
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
SG Ambulatory surgical center (asc) facility service
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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