CPT® Code 31546

Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with graft(s) (includes obtaining autograft)

The procedure described by CPT® Code 31546 involves a direct laryngoscopy that is performed operatively with the aid of an operating microscope or telescope. This procedure is specifically designed for the submucosal removal of non-neoplastic lesions located on the vocal cords. The term "non-neoplastic" refers to lesions that are not cancerous, indicating that the procedure is focused on benign conditions affecting the vocal cords. During the operation, the physician utilizes a direct laryngoscope, which can be either a rigid angled scope or a flexible scope, to visualize the laryngeal structures directly. The rigid scope is typically preferred for surgical interventions and is inserted through the mouth while the patient is under general anesthesia. The examination encompasses the oral cavity, oropharynx, hypopharynx, and trachea, allowing for a comprehensive view of the vocal cords. Once the laryngoscope is positioned, an operating microscope or telescope is employed to closely examine the lesion and assess its extent. The surgical technique involves the use of specialized instruments such as micro-knives and micro-scissors to carefully incise the vocal cord tissue. The surgeon performs both blunt and sharp dissection to meticulously separate the lesion from the surrounding healthy tissue. In cases where the surgical defect is less extensive, as noted in CPT® Code 31545, a local tissue flap may be utilized to close the defect. However, in the context of CPT® Code 31546, the lesion typically involves deeper tissues, necessitating the use of an autograft for reconstruction. An autograft is a tissue graft harvested from the patient's own body, which is then prepared and placed beneath a mucosal flap to effectively reconstruct the soft tissue defect created by the lesion's removal. The mucosal flap is secured in place with sutures, ensuring proper healing and restoration of the vocal cord structure.