# Comparing Utilization of Operative versus Awake Laryngoplasty Techniques in the United States Medicare Population: 22‐Year Trends

## TL;DR

This study examines trends in laryngoplasty techniques in the U.S. Medicare population from 2001 to 2022, finding a significant increase in awake procedures over time.

## Contribution

The study provides updated 22-year trends in awake versus operative laryngoplasty utilization using current procedural terminology codes.

## Key findings

- Awake injection procedures increased by 412.77% from 2001 to 2022.
- Operative injections remained more common than awake procedures until 2017.
- The introduction of CPT code 31574 in 2017 coincided with a rise in awake injection use.

## Abstract

Injection laryngoplasty (IL) is performed to correct glottic insufficiency. There has been a purported shift away from operative techniques in favor of awake, in‐office procedures, but no studies comparing utilization include updated current procedural terminology (CPT) coding. We analyzed the usage of operative versus awake injections CPT codes over 2 decades, recognizing that these encompass a broad array of injection procedures.

Retrospective database study.

United States Medicare Population from 2001 to 2022.

Utilization and reimbursement data compiled by the US Centers for Medicare & Medicaid Services were queried for CPT codes encompassing awake injections (31513, 31573, 31574), operative ILs (31570, 31571), and operative medialization laryngoplasties (31588, 31591).

10,186 injections were performed in 2022, a 195% increase from 2001. Awake injections grew by 412.77%, while operative injections grew by 134.75%. Operative injections are still more common (79.4% in 2001; 64.24% in 2022) and population‐adjusted use of 31571 grew between 2001 and 2021, while 31570 decreased. Since its adoption in 2017, awake IL code 31574 increased by 66.6%. From 2001 to 2006, the annual growth rate of awake injections was significantly lower than that of operative IL (P < .0001). From 2017 onwards, the awake IL growth rate was significantly higher than operative injections (P = .020).

Awake injection utilization increased over the 22‐year period, as introduction of code 31574 coincided with a relative decline in operative and an increase in awake IL. Otolaryngologists may be implementing awake injections due to reduced recovery time and introduction of more specific CPT codes.