🔪 CPT 31552 — Laryngoplasty; With Graft, Dilation, and Stenting, for Laryngeal Stenosis, Age 12 or Over
Quick Reference
wRVU: 22.50¹ | Global Period: 090 | Assistant Payable: Yes | Bilateral Indicator: 0 Rule: CPT 31552 carries a bilateral indicator of 0 because the larynx and trachea are single midline structures, so modifier -50 never applies. This code is specific to patients age 12 or older with laryngeal stenosis and requires all three elements — graft placement, dilation, and stenting — performed through a tracheotomy access approach. The age threshold distinguishes it from the pediatric equivalent, which is reported with a different code when the patient is under 12.
📋 Clinical Description
CPT 31552 describes an open laryngoplasty performed through a tracheotomy in a patient age 12 or older to correct laryngeal stenosis. The surgeon dilates the narrowed segment, releases any webs present, places a cartilage graft to provide structural support, and inserts a stent to maintain the airway lumen during healing.
This code requires all three procedural elements — graft, dilation, and stenting — to be performed and documented; if a graft is not placed, a different code in the 31551-31554 family applies instead. Compared to 31551 (the same procedure without graft, age under 12), 31552 is distinguished both by the adult/adolescent age threshold and by the addition of a cartilage graft for structural reinforcement.
Clinical contexts:
- Acquired subglottic or laryngotracheal stenosis following prolonged intubation or tracheostomy, requiring graft-based reconstruction.
- Idiopathic subglottic stenosis in adult patients not adequately managed by endoscopic dilation alone.
- Post-traumatic laryngeal stenosis from external neck trauma requiring structural grafting.
- Recurrent stenosis after failed prior endoscopic or open repair, requiring revision laryngoplasty with grafting.
- Congenital laryngeal stenosis persisting into adolescence or adulthood, requiring definitive open reconstruction.
🔬 Anatomical & Procedural Considerations
| Variant | Mechanism | Key Notes |
|---|---|---|
| Tracheotomy Access | The surgeon creates or utilizes an existing tracheotomy to gain access to the laryngeal framework, avoiding the need for a separate anterior laryngeal split in some cases. | The presence of a pre-existing tracheostomy at the time of surgery should be documented, as it affects the approach and may influence bundling considerations. |
| Dilation and Web Release | Stenotic segments are mechanically dilated and any laryngeal webs are incised to restore luminal diameter before graft placement. | Dilation alone without grafting would be reported under a different, less extensive code. |
| Graft and Stent Placement | A cartilage graft (often costal cartilage) is fashioned and secured to expand the laryngeal framework, followed by placement of an internal stent to maintain patency during healing. | The stent is typically removed in a later, separately reportable staged procedure once healing is confirmed. |
Clinical Pearl
✅ Procedure Includes
- Access to the larynx via tracheotomy.
- Dilation of the stenotic laryngeal segment.
- Release of laryngeal webs when present.
- Harvest and placement of a cartilage graft for structural support.
- Insertion of an internal laryngeal stent.
- Closure of the surgical access site.
❌ Excludes / Do Not Report Together
| Code | Description | Relationship |
|---|---|---|
| 31551 | Laryngoplasty; without graft, dilation, and stenting, for laryngeal stenosis, age under 12 | Represents the pediatric, non-graft variant; not reported together since only one code in this family applies per encounter based on age and graft status. |
| 31580 | Laryngoplasty; for laryngeal web, with indwelling keel or stent insertion | A more limited procedure addressing webs alone without the full graft-based reconstruction described by 31552. |
| 31599 | Unlisted procedure, larynx | Should not be used when 31552 accurately describes the graft, dilation, and stenting procedure performed. |
Bundling Alert
The 090-day global period bundles routine postoperative visits, stent monitoring, and wound checks within 90 days. Planned stent removal performed later as a staged procedure requires modifier -58, while an unplanned return to the OR for airway compromise or graft failure requires modifier -78. Audit risk increases when only partial elements of the procedure (e.g., dilation alone) were performed but billed as the full graft-and-stent code.
🌳 Code Tree — Surgery: Larynx
CPT 31300-31599 Surgery: Larynx
│
├── 31300-31420 Excision (Larynx, Arytenoid, Epiglottis)
│ ├── 31365 Laryngectomy; total, with radical neck dissection
│ └── 31400 Arytenoidectomy or arytenoidopexy, external approach
│
├── 31541-31580 Repair (Larynx)
│ ├── 31551 Laryngoplasty; without graft, dilation, and stenting, for laryngeal stenosis, age under 12
│ ├── ▶▶ 31552 ◀◀ Laryngoplasty; with graft, dilation, and stenting, for laryngeal stenosis, age 12 or over ← YOU ARE HERE (Global: 090)
│ ├── 31553 Laryngoplasty; without graft, dilation, and stenting, for laryngeal stenosis, age under 12 with cricotracheal resection
│ └── 31554 Laryngoplasty; with graft, dilation, and stenting, for laryngeal stenosis, age 12 or over with cricotracheal resection
│
└── 31580-31599 Laryngoplasty (Web, Fracture) / Unlisted
├── 31580 Laryngoplasty; for laryngeal web, with indwelling keel or stent insertion
└── 31599 Unlisted procedure, larynx💰 RVU & Reimbursement Profile
| Component | Value |
|---|---|
| Work RVU | 22.50¹ |
| Global Period | 090 |
| Bilateral Indicator | 0 |
| Assistant Surgeon | Payable |
| Co-Surgeon | Payable with documentation |
| Team Surgery | Not typically applicable |
| PC/TC Split | 0 |
| Modifier -51 Exempt | No |
| Anesthesia | General; billed separately |
Bilateral Billing Rules
Modifier -50 is never appropriate for 31552 because the larynx and trachea are single midline structures with no paired anatomic counterpart. There is no bilateral variant of this procedure, so laterality modifiers do not apply. Any staged revision or stent removal is instead addressed through modifier -58 or -78 rather than bilateral billing conventions.
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -22 | Increased Procedural Services | For revision cases with significant scarring or complex multi-level stenosis requiring substantially more operative work than typical. |
| -51 | Multiple Procedures | When 31552 is performed alongside another separately reportable procedure in the same operative session. |
| -58 | Staged/Related Procedure | When a planned staged procedure, such as later stent removal or graft revision, 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 graft failure 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 |
|---|---|---|---|
| J38.6 | Stenosis of larynx | No | The primary and most direct indication for 31552, capturing acquired or unspecified laryngeal stenosis. |
| Q31.1 | Congenital subglottic stenosis | No | Used when the stenosis is congenital in origin but persists into adolescence or adulthood requiring this procedure. |
Secondary Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| J95.5 | Post-procedural subglottic stenosis | No | Used when the stenosis is a direct consequence of prior intubation or airway procedure, a common etiology for this surgery. |
| R06.02 | Shortness of breath | No | Common presenting symptom supporting medical necessity for airway reconstruction. |
Etiology / Complication
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| T81.4XXA | Infection following a procedure, initial encounter | No | Reported if a postoperative surgical site or graft 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 whether the stenosis is congenital, post-procedural, or idiopathic, since this affects diagnosis code selection and supports medical necessity. Never report an unspecified stenosis code when the etiology (e.g., post-intubation) is documented elsewhere in the chart. Confirm patient age at the time of surgery is 12 or older, since this is a required element for correct code selection over the pediatric equivalent.
🏥 MS‑DRG Considerations
Inpatient 31552 typically groups to an ENT/respiratory surgical DRG reflecting airway reconstruction complexity. Because patients undergoing this procedure often have significant comorbidities related to the underlying cause of stenosis (prolonged intubation, prior tracheostomy, trauma), accurate secondary diagnosis capture — including respiratory failure or postoperative complications — can meaningfully affect DRG weighting and reimbursement.
🔧 ICD‑10‑PCS Equivalents
| PCS Code | Full Description | Modality |
|---|---|---|
| 0CQS0ZZ | Repair larynx, open approach | Open surgical repair component of the reconstruction |
| 0CUS07Z | Supplement larynx with autologous tissue substitute, open approach | Reflects the cartilage graft placement component |
| 0C9S0ZZ | Drainage of larynx, open approach | May apply if concurrent drainage is performed during access |
| 0CH97DZ | Insertion of intraluminal device into trachea, via natural or artificial opening | Reflects the stent placement component via the tracheotomy access |
PCS Character Analysis
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | 0 | Medical and Surgical section. |
| 2 | Body System | C | Respiratory system. |
| 3 | Root Operation | U | Supplementation — putting in biological or synthetic material to reinforce a body part, matching the cartilage graft placement. |
| 4 | Body Part | S | Larynx, the primary structure being reconstructed. |
| 5 | Approach | 0 | Open approach, matching the tracheotomy access technique. |
| 6 | Device | 7 | Autologous tissue substitute, reflecting the cartilage graft material. |
| 7 | Qualifier | Z | No qualifier needed for this component. |
Root Operation Comparison
Supplementation (U) is used for the graft placement because it reinforces the existing laryngeal structure with additional tissue rather than replacing it entirely. This differs from Repair (Q), which would apply to simple restoration of a structure to its original state without added material. Stenting is coded separately under Insertion (H) since a device is being placed within the lumen rather than tissue being added or repaired.
📝 Coding Examples
Example 1
Clinical Scenario: A 34-year-old female with idiopathic subglottic stenosis and prior failed endoscopic dilation undergoes open laryngoplasty via tracheotomy access, with costal cartilage graft placement, dilation of the stenotic segment, and insertion of an internal stent to maintain patency during healing.
| Field | Code | Rationale |
|---|---|---|
| CPT | 31552 | Captures the complete graft, dilation, and stenting procedure performed through tracheotomy access in an adult patient. |
| PDx | J38.6 | Documents the laryngeal stenosis as the primary indication for the reconstruction. |
Note
Confirm all three required elements — graft, dilation, and stenting — are documented, since the absence of any one element would require a different code selection.
Example 2
Clinical Scenario: A 16-year-old male with post-intubation subglottic stenosis from a prolonged ICU admission undergoes laryngoplasty with cartilage graft, dilation, and stent placement via existing tracheostomy access.
| Field | Code | Rationale |
|---|---|---|
| CPT | 31552 | Reflects the age-12-or-over graft, dilation, and stenting procedure, appropriate since the patient is 16 years old. |
| PDx | J95.5 | Documents the post-procedural etiology of the stenosis, directly linking it to the prior intubation. |
Note
Document the underlying cause of stenosis clearly, since post-procedural stenosis codes support a more specific and accurate clinical picture than a generic stenosis diagnosis.
Example 3
Clinical Scenario: A 40-year-old male undergoes laryngoplasty with graft, dilation, and stenting for laryngeal stenosis. Eight weeks postoperatively, within the global period, he returns for a planned staged procedure to remove the internal stent once healing is confirmed.
| Field | Code | Rationale |
|---|---|---|
| CPT | 31552-58 | Reports the planned staged stent removal performed within the global period of the index surgery. |
| PDx | J38.6 | Continues to document the laryngeal stenosis as the underlying condition being treated. |
Global period reminder
Modifier -58 is required to indicate the staged, planned nature of the stent removal and to override the global period bundling edit that would otherwise deny separate payment.
⚠️ Common Coding Pitfalls
- Reporting 31552 when only dilation was performed without graft placement or stenting, which requires a different, less extensive code.
- Using the pediatric-specific code 31551 for a patient age 12 or older, rather than the age-appropriate 31552.
- Failing to append modifier -58 for a planned staged stent removal performed within the global period.
- Defaulting to unspecified stenosis diagnosis codes when the etiology (post-procedural, congenital, traumatic) is clearly documented elsewhere in the chart.
- Confusing 31552 with 31580 (laryngoplasty for laryngeal web), which addresses a different, more limited pathology.
- Separately billing routine postoperative stent monitoring or wound checks directly tied to expected surgical recovery within the global period.
Sources:
1. AAPC. "CPT® Code 31552 - Repair Procedures on the Larynx." AAPC Codify, 2026 code changes reviewed. 2. Find-A-Code. "CPT® 31552 in section: Laryngoplasty." 2026.