Nasolaryngoscopy in a Family Medicine Clinic: Indications, Findings, and Economics

Article Figures & Data

Table 1.

Demographics of Patients Referred for Nasolaryngoscopy (n = 276)

Table 2.

Indications for Nasolaryngoscopy (n = 276)

	Age (years)			Sex			Race			Alcohol Use			Tobacco Use
	<50	≥50	P^*	Female	Male	P	Black	White	P	None	Ever	P	None	Ever	P
Symptoms
Chronic cough	17 (14.2)	30 (19.9)	.22	38 (19.4)	9 (11.4)	.11	18 (15.0)	22 (17.7)	.56	34 (18.9)	12 (14.0)	0.32	30 (18.1)	17 (16.3)	.72
Globus sensation	41 (34.2)	47 (31.1)	.60	65 (33.2)	23 (29.1)	.52	33 (27.5)	47 (37.9)	.08	54 (30.0)	32 (37.2)	0.24	55 (33.1)	31 (29.8)	.57
Hoarseness	59 (49.2)	81 (53.6)	.46	103 (52.6)	38 (48.1)	.50	65 (52.4)	62 (51.7)	.91	93 (51.7)	44 (51.2)	0.94	81 (48.8)	58 (55.8)	.26
Reflux	6 (5.0)	9 (6.0)	.73	13 (6.6)	2 (2.5)	.18	10 (4.1)	4 (3.2)	.09	10 (5.6)	5 (5.8)	0.93	9 (5.4)	6 (5.8)	.91
Sore throat	17 (14.2)	13 (8.6)	.15	24 (12.2)	6 (7.6)	.26	14 (11.3)	12 (10.0)	.74	23 (12.8)	6 (20.7)	0.16	21 (12.7)	8 (7.7)	.20
Diagnoses
Chronic rhinitis	24 (20.0)	13 (8.6)	.007	24 (12.2)	13 (16.5)	.35	19 (15.8)	14 (11.3)	.30	27 (15.0)	9 (10.5)	0.31	26 (15.7)	10 (9.6)	.16
Chronic sinusitis	11 (9.2)	4 (2.6)	.02	11 (5.6)	4 (5.1)	.86	8 (6.7)	5 (4.0)	.36	9 (5.0)	3 (3.5)	0.58	11 (5.5)	3 (4.3)	.69
Dysphagia	4 (3.3)	13 (8.6)	.08	10 (5.1)	7 (8.9)	.24	7 (5.8)	10 (8.1)	.49	6 (3.3)	11 (12.8)	0.003	7 (4.2)	10 (9.6)	.08
Epistaxis	5 (4.2)	10 (6.6)	.38	12 (6.1)	6 (7.6)	.66	9 (7.5)	8 (6.5)	.75	9 (5.0)	8 (9.3)	0.18	12 (7.2)	6 (5.8)	.64
Hemoptysis	2 (1.7)	1 (0.7)	.43	2 (1.0)	1 (1.3)	.86	2 (1.7)	0 (0.0)	.15	3 (1.7)	0 (0.0)	0.23	3 (1.8)	0 (0.0)	.17
History of vocal cord polyp	1 (0.8)	7 (4.6)	.07	5 (2.6)	3 (3.8)	.58	3 (2.5)	2 (1.6)	.63	5 (2.8)	2 (2.3)	0.83	1 (0.6)	7 (6.7)	.004

Values provided as n (%). Note that denominator numbers may vary slightly from numbers listed in Table 1 because of missing data for that particular analysis.
* χ² analyses for other demographics.

Table 3.

Findings from Completed Nasolaryngoscopy (n = 273)*

* Three of the 276 patients did not complete the entire nasolaryngoscopy procedure.
† Percentages do not sum to 100% because patients may have had more than one finding.
‡ “Other” includes tissue hypertrophy, acute inflammation, aspiration, eustachian tube dysfunction, candidal infection, septal perforation, bony spur, aphthous ulcer, vocal cord dysfunction, prominent vessel, and hemangioma.

Table 4.

Management Changes After Nasolaryngoscopy (n = 276)

Management	n (%)^*
Medication changes
Added	140 (50.7)
Deleted	9 (3.3)
Referrals
Otolaryngology	72 (26.1)
Gastroenterology	8 (2.9)
Other diagnostic tests
CAT scan	18 (6.5)
Barium swallow	14 (5.1)
Esophagogastroduodenoscopy	12 (4.3)
Repeat nasolaryngoscopy	5 (1.8)
Other^†	16 (5.8)
No changes to therapeutic plan	56 (20.3)

* Percentages do not sum to 100% because patients may have had more than one change.
† “Other” includes sleep study, allergy/immunology consult, manometry, pillcam, and transnasoesophagoscopy.
CAT, computed axial tomography.

Table 5.

Referral Outcomes*

	Referred patients^† (n = 127)(n [%])	Overall (n = 276) (%)
Referral Outcome
Laryngeal cancer (confirmed by biopsy)	3 (2.4)	(1.1)
Vocal cord lesion	9 (7.1)	(3.3)
Laryngopharyngeal reflux	25 (19.7)	(9.1)
Other^‡	40 (31.5)	(14.5)

* Patient may have more than one outcome.
† One hundred twenty-seven patients were referred for follow-up assessment by otolaryngology or gastroenterology or for other diagnostic tests.
‡ “Other outcome” includes vocal cord granuloma, sinonasal disease, nodules, vocal cord polyp, esophageal cancer with metastasis, parotid adenoma, small cell lung cancer, enlarged thyroid, esophagitis, and gastritis.

Table 6.

Estimated Breakeven Points Assuming Various Ratios of Payor Sources and Current Procedural Technology (CPT) Billing Codes

Relative CPT Billing Code Ratio^*	Relative Payor Ratio (Medicare/Private Insurance)
	0%/100%	20%/80%	40%/60%	60%/40%	80%/20%	100%/0%
0% 92511	56	66	78	97	129	190
100% 31575
20% 92511	66	76	90	110	141	199
80% 31575
40% 92511	79	90	105	125	156	208
60% 31575
60% 92511	98	111	126	147	175	218
40% 31575
80% 92511	131	143	158	176	199	229
40% 31575
100% 92511	197	205	213	222	231	242
0% 31575

Data are presented as Q values at different payor mix and CPT code ratios. Q equals the no. of procedures required to breakeven at the end of the first year, calculated as: where N equals the percentage of procedures performed coded as nasopharyngoscopy; L equals the percentage of procedures performed coded as laryngoscopy; M equals the percentage of procedures covered by Medicare insurance; P equals the percentage of procedures covered by private insurance; and T equals the total estimated startup costs for the first year ($12,850).
* CPT code 92511: Nasopharyngoscopy with endoscope; CPT code 31575: Laryngoscopy, flexible fiber optic.