National trends in laryngeal biopsy: Comparison of operative vs. office-based procedures

To analyze national trends and prevalence of office-based endoscopy with laryngeal biopsy procedures as compared to traditional operative biopsy procedures utilizing direct laryngoscopy with and without microlaryngoscopy.

The US Medicare Part B claims database was queried for Current Procedural Terminology (CPT) codes 31,576 (flexible laryngoscopy with biopsy), 31,535 (operative direct laryngoscopy with biopsy), and 31,536 (operative direct microlaryngoscopy with biopsy). From 2013 to 2022, the total number of charges billed to the Medicare database in each calendar year was recorded and annual trends were analyzed.

The number of office-based flexible laryngoscopy biopsy procedures (CPT code 31576) remained relatively constant over the 10-year period of analysis (range: 551-852, trendline slope = -21, R² = 0.51). Office-based flexible laryngoscopy biopsy procedures comprised a small portion of total laryngeal biopsies (range: 3.8 % - 4.8 %). The total number of operative direct laryngoscopy with biopsy, billed by CPT codes 31,535 and 31,536 experienced decline with time (Trendline slope = -310, R² = 0.89; Trendline slope = -254, R² = 0.85 respectively).

Office-based laryngeal biopsy procedures comprise a small fraction of laryngeal biopsy procedures overall and prevalence has declined slightly over the last 10 years. This contrasts with prevailing healthcare trends towards less-invasive, office-based procedures. Further research is needed to determine the etiology of the overall decrease in operative direct laryngeal biopsies.