Here’s the Latest Angle on Canalith Repositioning

Code prompts debate over CMS choice to bundle with E/M procedure.

By Brad Ericson, MPC, CPC, COSC

CPT® 2009 added new canalith repositioning (CRP) code 95992 Canalith repositioning procedure(s) (e.g. Epley maneuver, Semont maneuver), per day. The procedure is used to treat vertigo and involves therapeutic maneuvering of the patient’s body and head, using gravity and patience to redeposit calcium crystal debris in the semicircular canal system. The American Medical Association (AMA) Relative Value Update Committee (RUC) valued the service at 20 minutes of intra-service time.

Evaluation and Management – CEMC

In the Epley procedure, the therapist moves the patient’s head and body in a prescribed way, waiting 30 seconds before repositioning the patient. After several movements, the patient is tested for vertigo. If the modality fails, it’s repeated.

Any joy providers and coders felt over the introduction of this code was offset when the Centers for Medicare & Medicaid Services (CMS) released the 2009 Medicare Physician Fee Schedule (MPFS), which assigned a B (bundled) status indicator to it. No separate Medicare payment was available for the service, which instead was to be included in any evaluation and management (E/M) service provided on the same date. At the time, CMS acknowledged neurologists and therapists most commonly performed the procedure.

Almost immediately, CMS received comments questioning its decision to bundle 95992. Commentors pointed out therapists are unable to bill E/M services. Therapists would be precluded, they said, from using another code to report canalith repositioning because CPT® correct coding instructions require that the provider select the code that most accurately defines the service provided. Therapists would be unable to report or receive any reimbursement for a service they legitimately might provide.

Temporary Positioning

CMS sought to correct its mistake by issuing temporary guidance allowing therapists to report CRP for Medicare claims using “always therapy” code 97112 Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities.

Medlearn Matters article MM6397, issued March 4, 2009, instructed:

“The 2009 MPFS Final Rule … discussed a newly created CPT code, 95992, describing canalith repositioning procedures … CMS assigned the code a status indicator of B (bundled), and stated that bundling this code is most appropriate because this service is currently being paid for as part of an Evaluation and Management (E/M) service. However, since therapists also provide this service and they cannot bill for E/M services, they should continue to bill CPT code 97112 for this service.”

Resource tip: Access Medlearn Matters article MM6397, issued March 4, 2009, at the CMS website: www.cms.hhs.gov/MLNMattersArticles/downloads/MM6397.pdf.

CMS Finds Its Balance

For 2010, CMS assigned a revised status indicator of I (Not valid for Medicare purposes) to 95992. Medicare simply does not recognize the code. The 2010 MPFS Final Rule explains, “Canalith repositioning has been billed using E/M codes and therapy service codes in the past and we believe it should continue to be billed this way.”

Resource tip: The 2010 MPFS Final Rule was printed in the Nov. 25, 2009 Federal Register available for viewing at: http://edocket.access.gpo.gov/2009/pdf/E9-26502.pdf. The information on CRP begins on page 61766 (page 30 of the viewable PDF file).

Adjustments in the 2010 MPFS now cement CMS’ earlier guidance on billing CRP as below:

  • Physicians will continue to be paid for CRP using E/M codes. The CRP will be factored into E/M code selection for any E/M services provided on that date.
  • Physical therapists will continue to use 97112 for CRP.

According to CMS, this reporting “will enable beneficiaries to continue to receive this service while at the same time it will address our concerns about the potential for duplicate billing for this service to the extent that this service is paid as a part of an E/M service.”

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