🔪 CPT 31400 — Arytenoidectomy or Arytenoidopexy, External Approach
Quick Reference
wRVU: 11.31¹ | Global Period: 090 | Assistant Payable: Yes | Bilateral Indicator: 0 Rule: CPT 31400 carries a bilateral indicator of 0 because arytenoid procedures are typically performed unilaterally to open the airway; performing the procedure on both sides in the same session risks bilateral vocal fold immobility, so modifier -50 is generally not applicable. This code describes an external (open) approach only — an endoscopic arytenoidectomy is reported with a different code. Documentation must clearly specify “external approach” to support 31400 rather than an endoscopic alternative.
📋 Clinical Description
CPT 31400 describes surgical removal (arytenoidectomy) or repositioning (arytenoidopexy) of the arytenoid cartilage through an open, external cervical approach. This procedure is most commonly performed to enlarge the posterior glottic airway in patients with bilateral vocal fold paralysis causing airway obstruction, allowing avoidance or reversal of a permanent tracheostomy.
Unlike endoscopic arytenoid procedures performed via direct laryngoscopy, 31400 requires an external neck incision to access the larynx, making it more invasive but allowing greater surgical control in complex or revision cases. It differs from thyroplasty procedures, which reposition the vocal fold via an external window without removing cartilage, since 31400 specifically targets the arytenoid cartilage itself.
Clinical contexts:
- Bilateral vocal fold paralysis causing airway obstruction, where posterior glottic widening is needed to avoid a permanent tracheostomy.
- Arytenoid dislocation or fixation following prior intubation trauma, requiring repositioning.
- Failed endoscopic arytenoid procedures requiring an open revision approach.
- Cricoarytenoid joint ankylosis limiting vocal fold mobility and airway patency.
- Combined airway-widening procedures performed alongside other open laryngeal surgery in the same setting.
🔬 Anatomical & Procedural Considerations
| Variant | Mechanism | Key Notes |
|---|---|---|
| Arytenoidectomy | The surgeon removes all or part of the arytenoid cartilage through an external laryngeal approach, widening the posterior glottic airway to relieve obstruction from bilateral vocal fold paralysis. | Complete versus partial arytenoidectomy should be documented, since the extent of cartilage removal affects postoperative voice and swallow outcomes. |
| Arytenoidopexy | Rather than removing cartilage, the surgeon repositions and secures the arytenoid laterally using sutures placed through an external approach, preserving cartilage while widening the airway. | Arytenoidopexy is often preferred over arytenoidectomy when preserving some vocal fold mobility and voice quality is a priority. |
| External Approach | A cervical skin incision and laryngeal framework exposure are required to reach the arytenoid, distinguishing this from endoscopic techniques performed entirely through the mouth. | The external approach allows more precise suture placement for arytenoidopexy but carries a longer recovery than endoscopic alternatives. |
Clinical Pearl
Confirm the operative note specifies an external (open) approach with cervical incision — if the procedure was performed entirely transorally via direct laryngoscopy, 31400 is not the correct code and an endoscopic arytenoid code should be used instead.
✅ Procedure Includes
- External cervical incision and exposure of the laryngeal framework.
- Removal (arytenoidectomy) or suture repositioning (arytenoidopexy) of the arytenoid cartilage.
- Widening of the posterior glottic airway.
- Hemostasis and closure of the laryngeal framework and neck incision.
- Placement of a surgical drain when indicated.
❌ Excludes / Do Not Report Together
| Code | Description | Relationship |
|---|---|---|
| 31599 | Unlisted procedure, larynx | Should not be used when 31400 accurately describes the external arytenoid procedure performed; reserve unlisted codes for truly atypical procedures. |
| 31580 | Laryngoplasty; for laryngeal web, with indwelling keel or stent insertion | A distinct laryngeal reconstruction procedure addressing webbing, not arytenoid pathology; not reported together for the same anatomic target. |
| 31584 | Laryngoplasty, for laryngeal fracture; with open reduction | Addresses traumatic fracture reduction rather than arytenoid removal or repositioning; performed for different indications. |
Bundling Alert
The 090-day global period bundles routine postoperative visits, voice/swallow evaluations tied to expected recovery, and wound checks within 90 days. An unplanned return to the OR for airway compromise or bleeding within the global period requires modifier -78, while a planned staged procedure (such as a contralateral arytenoid procedure performed later) requires modifier -58. Audit risk increases when the external approach is billed but documentation actually supports an endoscopic technique.
🌳 Code Tree — Surgery: Larynx
CPT 31300-31599 Surgery: Larynx
│
├── 31300-31320 Laryngotomy/Laryngostomy
│ ├── 31300 Laryngotomy, with removal of tumor, laryngocele, or web
│ └── 31320 Laryngotomy, diagnostic
│
├── 31360-31382 Excision (Larynx)
│ ├── 31360 Laryngectomy; total, without radical neck dissection
│ └── 31365 Laryngectomy; total, with radical neck dissection
│
├── 31390-31395 Pharyngolaryngectomy
│ └── 31390 Pharyngolaryngectomy, with radical neck dissection; without reconstruction
│
└── 31400-31420 Excision/Repair (Arytenoid, Epiglottis)
├── ▶▶ 31400 ◀◀ Arytenoidectomy or arytenoidopexy, external approach ← YOU ARE HERE (Global: 090)
├── 31420 Epiglottidectomy
└── 31580 Laryngoplasty; for laryngeal web, with indwelling keel or stent insertion💰 RVU & Reimbursement Profile
| Component | Value |
|---|---|
| Work RVU | 11.31¹ |
| Global Period | 090 |
| Bilateral Indicator | 0 |
| Assistant Surgeon | Payable |
| Co-Surgeon | Rarely applicable |
| Team Surgery | Not typically applicable |
| PC/TC Split | 0 |
| Modifier -51 Exempt | No |
| Anesthesia | General; billed separately |
Bilateral Billing Rules
Modifier -50 is generally not appropriate for 31400 because bilateral arytenoid procedures in the same session risk creating bilateral vocal fold immobility and airway compromise, so this procedure is almost always performed unilaterally. If a contralateral procedure is later required as a staged approach, it should be reported with modifier -58 on a subsequent claim rather than billed bilaterally in one session. Documentation should always specify laterality even though a formal -RT/-LT modifier is not part of this code’s standard billing pattern.
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -22 | Increased Procedural Services | For revision cases or significant scarring from prior surgery requiring substantially more operative work than typical. |
| -51 | Multiple Procedures | When 31400 is performed alongside another separately reportable procedure in the same operative session. |
| -58 | Staged/Related Procedure | When a planned staged procedure, such as a delayed contralateral arytenoid procedure, is performed within the global period. |
| -78 | Return to Operating Room | For an unplanned, related return to the OR within the global period, such as for bleeding or airway compromise. |
| -79 | Unrelated Procedure | For an unrelated procedure performed by the same surgeon during the global period. |
🩺 Common ICD‑10‑CM Pairings
Primary Diagnosis Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| J38.00 | Paralysis of vocal cords and larynx, unspecified | No | Common primary diagnosis when laterality of vocal fold paralysis is not specified in documentation. |
| J38.02 | Paralysis of vocal cords and larynx, bilateral | No | The classic indication for 31400, since bilateral paralysis most often necessitates posterior glottic widening. |
| J38.3 | Other diseases of vocal cords | No | Used for arytenoid fixation or other structural vocal fold pathology not classified as paralysis. |
Secondary Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| M95.9 | Acquired deformity of musculoskeletal system, unspecified | No | May support documentation of arytenoid cartilage deformity when a more specific code is unavailable. |
| R06.02 | Shortness of breath | No | Common presenting symptom supporting medical necessity for airway-widening surgery. |
Etiology / Complication
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| T81.4XXA | Infection following a procedure, initial encounter | No | Reported if a postoperative surgical site infection develops within the global period. |
| J95.821 | Acute postprocedural respiratory failure | No | Reported if postoperative airway compromise develops requiring intervention within the global period. |
Coding Specificity Reminder
Always document and code the specific laterality of vocal fold paralysis when known, since J38.00 (unspecified) should be reserved for cases where laterality genuinely cannot be determined from clinical documentation. Never report a parent category code alone — J38 always requires additional characters to be billable. Confirm the etiology of the paralysis (e.g., prior thyroid surgery, intubation trauma) is documented elsewhere in the chart, as this supports medical necessity even though it is not directly coded on this claim.
🏥 MS‑DRG Considerations
Inpatient 31400 typically groups to a lower-weighted otolaryngology surgical DRG compared to major laryngectomy procedures, since it is a more limited cartilage procedure rather than an organ resection. Accurate capture of the underlying etiology (such as postoperative or post-intubation vocal fold paralysis) as a secondary diagnosis can support appropriate DRG assignment and reflect the complexity of the airway obstruction being treated.
🔧 ICD‑10‑PCS Equivalents
| PCS Code | Full Description | Modality |
|---|---|---|
| 0CB80ZZ | Excision of right vocal cord, open approach | Open excisional component near arytenoid region |
| 0CB90ZZ | Excision of left vocal cord, open approach | Open excisional component near arytenoid region |
| 0CS80ZZ | Reposition of right vocal cord, open approach | Reflects arytenoidopexy repositioning technique |
| 0CS90ZZ | Reposition of left vocal cord, open approach | Reflects arytenoidopexy repositioning technique |
PCS Character Analysis
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | 0 | Medical and Surgical section. |
| 2 | Body System | C | Respiratory system. |
| 3 | Root Operation | B or S | Excision (B) for arytenoidectomy; Reposition (S) for arytenoidopexy, depending on technique performed. |
| 4 | Body Part | 8 or 9 | Right or left vocal cord, the closest available PCS body part to the arytenoid region. |
| 5 | Approach | 0 | Open approach, matching the external cervical incision. |
| 6 | Device | Z | No device placed for excision; sutures used in repositioning are not separately coded as a device. |
| 7 | Qualifier | Z | No qualifier needed. |
Root Operation Comparison
Excision (B) is used for arytenoidectomy since cartilage tissue is being cut out without replacement, while Reposition (S) is used for arytenoidopexy since the cartilage is being moved to a new location and secured without removal. Coders should select the root operation based on which specific technique (removal versus repositioning) is documented in the operative note, since the two root operations are not interchangeable.
📝 Coding Examples
Example 1
Clinical Scenario: A 54-year-old female with bilateral vocal fold paralysis following total thyroidectomy presents with progressive stridor and exercise intolerance. She undergoes an external arytenoidectomy on the right side to widen the posterior glottic airway and avoid tracheostomy. The procedure is performed through a standard external cervical approach with no complications.
| Field | Code | Rationale |
|---|---|---|
| CPT | 31400 | Captures the external arytenoidectomy performed to relieve bilateral vocal fold paralysis-related airway obstruction. |
| PDx | J38.02 | Documents bilateral vocal fold paralysis as the underlying indication for the procedure. |
Note
Ensure the operative note specifies “external approach” and unilateral treatment side, since this supports correct code selection and medical necessity for a bilateral paralysis diagnosis treated unilaterally.
Example 2
Clinical Scenario: A 47-year-old male with post-intubation arytenoid dislocation undergoes external arytenoidopexy to reposition and secure the dislocated cartilage, restoring near-normal vocal fold position and airway patency.
| Field | Code | Rationale |
|---|---|---|
| CPT | 31400 | Reflects the arytenoidopexy component of the code, describing repositioning rather than removal. |
| PDx | J38.3 | Documents the structural vocal cord pathology consistent with arytenoid dislocation. |
Note
Clarify in the documentation that the arytenoid was repositioned (pexy) rather than removed (ectomy), since both techniques fall under 31400 but reflect different clinical approaches.
Example 3
Clinical Scenario: A 60-year-old male undergoes external arytenoidectomy for bilateral vocal fold paralysis. Fourteen days postoperatively, within the global period, he returns to the OR for a planned staged contralateral arytenoid procedure to further improve airway patency.
| Field | Code | Rationale |
|---|---|---|
| CPT | 31400-58 | Reports the staged, planned contralateral procedure performed within the global period of the index surgery. |
| PDx | J38.02 | Continues to document bilateral vocal fold paralysis as the underlying indication. |
Global period reminder
Modifier -58 is required to indicate the staged nature of the second procedure and to override the global period bundling edit that would otherwise deny separate payment.
⚠️ Common Coding Pitfalls
- Reporting 31400 when the procedure was actually performed endoscopically rather than through an external approach, which requires a different code.
- Failing to append modifier -58 when a planned staged contralateral procedure is performed within the global period.
- Using unspecified paralysis code J38.00 when the operative and clinical documentation actually supports bilateral (J38.02) or a more specific vocal cord diagnosis.
- Confusing arytenoidectomy with thyroplasty procedures, which reposition the vocal fold via an external window rather than targeting the arytenoid cartilage directly.
- Billing bilateral arytenoid procedures in a single session without recognizing the airway compromise risk and the resulting need for staged, separately billed encounters.
- Separately billing routine postoperative voice and swallow evaluations directly tied to expected surgical recovery within the global period.
Sources:
1. medicalfeeschedules.com. "CPT 31400 Medicare reimbursement rate: $933.89 (Q3 2026)." 2026. 2. AAPC. "CPT Code 31400 - Excision Procedures on the Larynx." AAPC Codify, 2026 code changes reviewed.