Crystal's Coder Hub🧬 CPT 31560 — Laryngoscopy, Direct, Operative, With Arytenoidectomy
Billable Code Confirmed
CPT 31560 is a valid, billable 5-character CPT for CY2026. This code describes direct operative laryngoscopy with arytenoidectomy. No additional characters are required.
Non-Billable Parent Codes — Never Submit These
- ❌
31520— Laryngoscopy direct, with or without tracheoscopy — diagnostic, bundled into 31560- ❌
31525— Laryngoscopy direct, diagnostic — bundled into 31560- ❌
31561— Mutually exclusive with 31560; use 31561 if operating microscope or telescope is usedAlways submit 31560 (all 5 characters) when direct operative laryngoscopy with arytenoidectomy is documented without use of an operating microscope or telescope.
Clinical Context: With vs. Without Operating Microscope/Telescope
CPT 31560 captures direct operative laryngoscopy with arytenoidectomy performed without an operating microscope or telescope. If the operative note documents use of an operating microscope or telescope, bill 31561 instead. The two codes are mutually exclusive — only one may be billed per session.
Code Classification
CPT Procedure Code — wRVU ~10.5 (estimated), Global Period 090, Assistant-at-Surgery: Not Payable (per CMS assistant-at-surgery policy for this code). Medicare facility payment ~$762 (2026).
🔍 Code Description
CPT 31560 classifies laryngoscopy, direct, operative, with arytenoidectomy. This code represents a surgical procedure where the surgeon performs a direct laryngoscopy (visualizing the larynx through the mouth using a rigid laryngoscope) and removes one or both arytenoid cartilages.
The arytenoid cartilages are paired pyramid-shaped cartilages in the larynx that articulate with the cricoid cartilage and serve as the attachment point for the vocal cords. Arytenoidectomy is typically performed to address bilateral vocal cord paralysis causing airway obstruction, severe laryngeal stenosis, or to improve voice and swallowing function when conservative measures have failed. The procedure may be performed via endoscopic (transoral) approach or as part of an open laryngofissure.
🌳 Code Tree / Hierarchy
31520 Laryngoscopy direct, with or without tracheoscopy ❌ Diagnostic — bundled
│ ├── 31525 Laryngoscopy direct, diagnostic ❌ Bundled into operative codes
│ ├── 31530 Laryngoscopy, direct, operative, with foreign body removal ✅ Billable
│ ├── 31535 Laryngoscopy, direct, operative, with biopsy ✅ Billable
│ ├── 31540 Laryngoscopy, direct, operative, with excision of tumor/stripping of vocal cords ✅ Billable
│ ├── 31560 Laryngoscopy, direct, operative, with arytenoidectomy ◀ THIS CODE ✅ Billable
│ ├── 31561 Laryngoscopy, direct, operative, with arytenoidectomy; with operating microscope or telescope ❌ Mutually exclusive with 31560
│ ├── 31570 Laryngoscopy, direct, with injection into vocal cord(s), therapeutic ✅ Billable
│ ├── 31580 Laryngoplasty; for laryngeal web, with indwelling keel or stent insertion ✅ Billable
│ ├── 31584 Laryngoplasty; with open reduction and fixation of fracture ✅ Billable
│ ├── 31587 Laryngoplasty, cricoid split, without graft placement ✅ Billable
│
└── 31590 Laryngeal reinnervation by neuromuscular pedicle ✅ Billable
Microscope/Telescope Documentation
The critical distinction between 31560 and 31561 is the use of an operating microscope or telescope. The operative note must explicitly state whether a microscope/telescope was used. If documented, bill 31561 (higher wRVU). If not documented, bill **31560****. Do not bill both codes for the same session.
✅ Includes
The following clinical terms and scenarios map to 31560 when documented:
- Direct operative laryngoscopy with arytenoidectomy
- Arytenoid cartilage removal via direct laryngoscopy
- Endoscopic arytenoidectomy (transoral approach)
- Partial or complete arytenoidectomy
- Arytenoidectomy for airway obstruction
- Arytenoidectomy for vocal cord paralysis
- Arytenoidectomy without operating microscope
❌ Excludes
Excludes 1 — Cannot Be Coded Simultaneously with 31560
| Code | Description | Note |
|---|---|---|
| 31520 | Laryngoscopy direct, with or without tracheoscopy | Diagnostic laryngoscopy is bundled into operative laryngoscopy; never bill together |
| 31525 | Laryngoscopy direct, diagnostic | Diagnostic laryngoscopy bundled into 31560 |
| 31561 | Laryngoscopy, direct, operative, with arytenoidectomy; with operating microscope or telescope | Mutually exclusive — select the code that matches documentation |
Excludes 1 Violation Risk
The most common coding error is billing 31520/31525 (diagnostic laryngoscopy) with 31560. NCCI edits bundle diagnostic laryngoscopy into operative laryngoscopy. If both diagnostic and operative laryngoscopy are performed, only 31560 is reported. Another common error is billing both 31560 and 31561 — these are mutually exclusive.
Excludes 2 — May Be Coded in Addition if Separately Present
| Code | Description | Note |
|---|---|---|
| 31530 | Laryngoscopy, direct, operative, with foreign body removal | May be separately billable if performed in a distinct session or for a separate indication |
| 31535 | Laryngoscopy, direct, operative, with biopsy | May be separately billable if distinct session |
📋 Clinical Overview
Arytenoidectomy Approach Comparison
| Feature | 31560 — Without Microscope/Telescope | 31561 — With Microscope/Telescope |
|---|---|---|
| Visualization | Direct vision via rigid laryngoscope | Enhanced visualization with operating microscope or telescope |
| Procedure Complexity | Moderate-High | High |
| wRVU (2026 est.) | ~10.5 | ~11.5 |
| Medicare Payment (2026) | ~$762 | ~$831 |
| Typical Setting | Hospital OR / ASC | Hospital OR |
| Indications | Airway obstruction, vocal cord paralysis, laryngeal stenosis | Same, with enhanced precision requirements |
CDI Query Trigger — Microscope/Telescope Use
When the operative note describes an arytenoidectomy but does not explicitly state whether an operating microscope or telescope was used, a CDI query should request: “Please confirm whether an operating microscope or telescope was used during the arytenoidectomy to support accurate CPT code selection (31560 without microscope vs. 31561 with microscope).”
Common Diagnoses / Clinical Indications
- Bilateral vocal cord paralysis: J38.00 (with laterality J38.01/J38.02) — most common indication for arytenoidectomy to relieve airway obstruction
- Laryngeal stenosis: J38.6 — posterior glottic stenosis, subglottic stenosis requiring arytenoidectomy as part of reconstruction
- Laryngeal web: J38.7 — may require arytenoidectomy with laryngoplasty
- Laryngeal tumor: C32.x — malignant neoplasm requiring partial laryngeal resection
- Laryngeal polyp/nodule: J38.1/J38.2 — less common indication
- Post-traumatic laryngeal injury: S19.8 — fracture or dislocation requiring arytenoidectomy
Coding Laterality
Always code the documented laterality for vocal cord paralysis. Examples include:
💰 HCC Risk Adjustment (CMS-HCC v28)
| Field | Detail |
|---|---|
| CMS-HCC Model Version | v28 (2024-2025 Implementation) |
| HCC Assignment | ❌ Not HCC-Mapped |
| HCC Category | N/A — CPT procedural code |
| RAF Coefficient | N/A |
31560 does not map to an HCC under v28 as it is a CPT procedure code, not a diagnosis code.
🏥 APC Assignment (Outpatient)
APC 5152 — Level 2 Ear, Nose, Mouth and Throat Procedures (J1)
| Setting | Payment Rate | Status Indicator |
|---|---|---|
| Hospital Outpatient (OPPS) | ~3,500 | J1 |
| ASC | Varies by payer | J1 |
| Physician Facility (2026) | ~$762 | A |
| Physician Non-Facility | N/A — Not typically performed in office | A |
Site-of-Service Impact
CMS 2026 PFS final rule reduced facility-based professional fees for many surgical procedures while increasing OPPS/ASC facility payments. Hospital-employed otolaryngologists may see lower professional fees for facility-based services. This procedure is typically performed in a hospital operating room or ASC due to anesthesia requirements.
🔗 Related CPT Codes
Laryngoscopy and Laryngoplasty Hierarchy
| Code | Description |
|---|---|
| 31560 | Laryngoscopy, direct, operative, with arytenoidectomy ← This Code |
| 31561 | Laryngoscopy, direct, operative, with arytenoidectomy; with operating microscope or telescope |
| 31520 | Laryngoscopy direct, with or without tracheoscopy (diagnostic) |
| 31540 | Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis |
| 31541 | Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope or telescope |
| 31580 | Laryngoplasty; for laryngeal web, with indwelling keel or stent insertion |
| 31587 | Laryngoplasty, cricoid split, without graft placement |
| 31590 | Laryngeal reinnervation by neuromuscular pedicle |
🛠️ Commonly Associated ICD-10-CM Diagnoses
Outpatient and Profee Setting Context
These ICD-10-CM codes commonly support medical necessity for CPT 31560 in the outpatient, ASC, and professional fee settings.
| ICD-10-CM | Description | Coding Notes |
|---|---|---|
| J38.01 | Paralysis of vocal cords and larynx, unilateral | Most common indication — specify side |
| J38.02 | Paralysis of vocal cords and larynx, bilateral | Critical airway obstruction indication |
| J38.1 | Polyp of vocal cord and larynx | If polyp involves arytenoid region |
| J38.2 | Nodules of vocal cords | Less common indication |
| J38.3 | Other diseases of vocal cords | Includes vocal cord granuloma, cyst |
| J38.4 | Edema of larynx | If edema requires surgical intervention |
| J38.5 | Laryngeal spasm | Rare indication |
| J38.6 | Stenosis of larynx | Posterior glottic/subglottic stenosis |
| J38.7 | Other diseases of larynx | Includes laryngeal web, perichondritis |
| C32.0 | Malignant neoplasm of glottis | Laryngeal cancer requiring resection |
| C32.1 | Malignant neoplasm of supraglottis | Laryngeal cancer |
| C32.2 | Malignant neoplasm of subglottis | Laryngeal cancer |
| C32.3 | Malignant neoplasm of laryngeal cartilage | Includes arytenoid cartilage malignancy |
| C32.8 | Malignant neoplasm of overlapping sites of larynx | Laryngeal cancer |
| C32.9 | Malignant neoplasm of larynx, unspecified | Laryngeal cancer |
| D14.1 | Benign neoplasm of larynx | Benign tumor requiring excision |
| S19.8- | Other specified injuries of neck | Post-traumatic laryngeal injury |
| J95.5 | Postprocedural subglottic stenosis | Iatrogenic stenosis requiring repair |
🔬 ICD-10-PCS Crosswalk (Inpatient Procedures)
When 31560 is performed in the inpatient setting, these PCS codes are relevant:
| PCS Section | Body System | Root Operation | Clinical Application |
|---|---|---|---|
| 0 — Medical and Surgical | C — Mouth and Throat | B — Excision | 0CBS0ZZ — Excision of larynx, open approach (arytenoidectomy via open/laryngofissure approach) |
| 0 — Medical and Surgical | C — Mouth and Throat | B — Excision | 0CBS4ZZ — Excision of larynx, percutaneous endoscopic approach (arytenoidectomy via transoral endoscopic approach) |
| 0 — Medical and Surgical | C — Mouth and Throat | 5 — Destruction | 0C5S0ZZ — Destruction of larynx, open approach (if laser/cautery destruction of arytenoid) |
💊 Coding Scenarios and Examples
Scenario 1 — Inpatient/OR: Bilateral Vocal Cord Paralysis With Arytenoidectomy
Clinical Vignette: A 58-year-old male presents with progressive dyspnea and stridor following thyroidectomy 6 months ago. Flexible laryngoscopy confirms bilateral vocal cord paralysis with paramedian positioning. CT neck shows no recurrent laryngeal nerve recovery. The patient undergoes direct laryngoscopy with arytenoidectomy of the left arytenoid cartilage to enlarge the posterior glottic airway. No operating microscope is used.
CPT Codes:
- 31560 — Laryngoscopy, direct, operative, with arytenoidectomy (primary procedure)
ICD-10-CM:
- [J38.02] — Paralysis of vocal cords and larynx, bilateral (primary diagnosis)
- Z48.22 — Encounter for aftercare following thyroidectomy (history)
- [R06.1] — Stridor (symptom)
Note: 31520/31525 (diagnostic laryngoscopy) is NOT billed separately. If E/M service was significant and separately identifiable on the same day, bill with modifier -25. If the decision for surgery was made on the same day as the procedure, modifier -57 may apply.
Scenario 2 — Outpatient/ASC: Posterior Glottic Stenosis With Arytenoidectomy
Clinical Vignette: A 45-year-old female with history of prolonged intubation 3 months ago presents with dyspnea on exertion and biphasic stridor. Flexible laryngoscopy reveals posterior glottic stenosis with interarytenoid scar band. She undergoes direct laryngoscopy with arytenoidectomy and lysis of interarytenoid adhesions. An operating microscope is used for enhanced visualization.
CPT Codes:
- 31561 — Laryngoscopy, direct, operative, with arytenoidectomy; with operating microscope or telescope (primary procedure — microscope documented)
ICD-10-CM:
- J38.6 — Stenosis of larynx (primary diagnosis)
- J95.5 — Postprocedural subglottic stenosis (etiology)
- R06.1 — Stridor (symptom)
Note: Because an operating microscope was documented, 31561 is billed instead of 31560. Do NOT bill 69990 (operating microscope) separately — it is included in 31561.
Scenario 3 — CDI Query: Missing Microscope Documentation
Clinical Vignette: Operative note states: “Direct laryngoscopy performed. Left arytenoidectomy completed using microsurgical instruments. Airway patency improved.” No explicit mention of “operating microscope” or “telescope” in the documentation.
Action / Outcome: Coding uncertainty: Cannot definitively determine if 31560 (without microscope) or 31561 (with microscope) is correct. The term “microsurgical instruments” does not necessarily mean an operating microscope was used. CDI query sent to surgeon.
Query Response: Provider clarifies: “Operating microscope was used for visualization during the arytenoidectomy.”
Corrected CPT Coding:
- 31561 — Laryngoscopy, direct, operative, with arytenoidectomy; with operating microscope or telescope (accurate code after CDI clarification)
⚠️ Coding Pitfalls and Tips
| Pitfall or Tip | |
|---|---|
| ❌ | Billing 31520/31525 with 31560. Diagnostic laryngoscopy is bundled into operative laryngoscopy. Never bill diagnostic and operative laryngoscopy for the same session. |
| ❌ | Billing both 31560 and 31561. These codes are mutually exclusive. Bill the code that matches the documentation — 31560 if no microscope, 31561 if microscope used. |
| ❌ | Billing 69990 with 31561. The operating microscope is included in 31561. Do not bill 69990 separately when 31561 is reported. |
| ❌ | Using 31560 for laser arytenoidectomy without excision. If the procedure involves laser destruction of the arytenoid without excision, consider whether 31560 is appropriate or if another code (e.g., 31540 with modifier) better describes the service. |
| ✅ | Modifier -25 for E/M. A significant, separately identifiable E/M service on the same day may be billed with modifier -25. |
| ✅ | Modifier -57 for decision for surgery. If the decision to perform the arytenoidectomy is made on the same day as the procedure, append modifier -57 to the E/M code. |
| ✅ | Modifier -22 for increased complexity. If the procedure requires significantly greater work (e.g., severe scarring, revision surgery, combined procedures), modifier -22 may be appended with supporting documentation. |
| ✅ | Document microscope use explicitly. The operative note must clearly state “operating microscope” or “telescope” to support billing 31561. Terms like “microsurgical instruments” or “magnification” are not sufficient. |
| ✅ | Code laterality for paralysis. Always specify unilateral (J38.01) or bilateral (J38.02) vocal cord paralysis to capture full clinical specificity. |
📚 Sources
1 CMS/NCHS. ICD-10-CM Official Guidelines for Coding and Reporting, FY2026. 2 AMA. CPT Professional Edition 2026. Surgery / Respiratory System. 3 CMS. CY2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F). Addendum B. 4 New Mexico Workers’ Compensation Administration. 2026 Health Care Provider Fee Schedule. CPT 31560 (830.57). 5 CMS. National Correct Coding Initiative (NCCI) Policy Manual, Chapter 8 — CPT Codes 30000-39999. 6 AAO-HNS. CPT for ENT: Laryngoscopy Coding Guidelines. 7 CMS. MLN907166 — Global Surgery Booklet. 8 CDC/NHSN. CPT Procedure Code Category: NECK.