Otolaryngology Coding Alert

No code? No worries with this helpful advice.

When a patient presents to your ENT office with suspected Eustachian tube dysfunction, your coder may sigh in frustration as the chart hits his desk. That’s because many instances of Eustachian tube dysfunction require extensive testing, and CPT® has yet to assign a definitive code to the service.

But before you just assign a tympanometry test or other “similar” code to your claim, consider another option—an unlisted code. This can not only help you better describe your service to the payer, but could also prompt the CPT® code selection committee to someday create a code that does describe this service, because use of the unlisted will show them the need for a code to assign to this service.

From Valsalva to Politzer and Beyond

Your practitioner may document that he performed a Eustachian tube dysfunction test, or could instead record the test by name in his notes. Some commonly-performed tests include Valsalva, Politzer, or Frenzel, but there are others as well that describe the provider’s interest in finding whether a tube dysfunction has occurred, either anatomically, following an infection, or for other reasons.

Some otolaryngology practices tell us they’ve had luck reporting 92567 (Tympanometry [impedance testing]), while others append modifier 22 (Increased procedural services) to denote that the work performed during the tympanometry isn’t as robust as what they provide during Eustachian tube testing. But the reality is that 92567 allows payment for the pressure reading only and not the additional tests required of a Eustachian tube test.

What Are the Eustachian Dysfunction Tests?

• During a Valsalva test, the otolaryngologist takes a pressure reading using a tympanometer. The physician then has the patient try to exhale while pinching his nose and keeping his mouth closed. A subsequent tympanogram shows whether the tube is open or closed.
• The Frenzel maneuver is the opposite of the Valsalva inflation. The patient takes a mouthful of air and, while keeping his mandible open, he closes his lips and pinches his nose. The air in the oral cavity is then compressed by raising the tongue and pressing the cheeks.
• During the Politzer test, the physician forces air up the Eustachian tube by having the patient close off his soft palate by either saying speaking or swallowing water, then blowing air into one nostril while the other one is pinched.
• The Toynbee test assesses the Eustachian tube function by having the patient pinch her nose while swallowing.

To encourage CPT® to identify the studies in the future, you should report unlisted procedure code 92700 (Unlisted otorhinolaryngological service or procedure). Since most carriers will no longer accept paper claims, submit your unlisted procedure code electronically with a short description of what was done in the electronic equivalent of box #19 of the CMS-1500 form.

Nail Down Your Diagnosis Code

Once the physician makes a diagnosis about the patient’s issue, you should report the specific Eustachian tube dysfunction code that describes the disorder, such as H69.01 (Patulous Eustachian tube, right ear). If the physician finds a Eustachian tube dysfunction that does not have a code assigned in ICD-10, you’ll need to report the appropriate code from the H69.8 series (Other specified disorders of the Eustachian tube).

If, however, the doctor does not specify the patient’s Eustachian tube disorder but he does diagnose her with one, report a code from the H69.9 series (Unspecified Eustachian tube disorder).

And finally, if the doctor performs the testing and finds nothing at all wrong, then simply report the ICD-10 code that describes the symptoms that prompted the testing. 

Appeal When Warranted

Even the best documentation won’t always get you the reimbursement your otolaryngologist deserves for an unlisted procedure code, and in some cases you may need to appeal to collect.

If your ENT physician uses equipment and techniques that have no dedicated CPT® codes, you may be able to enlist the manufacturer’s aid to receive appropriate reimbursement. Manufacturers often maintain free information and help lines to advise physician practices on how to approach insurers regarding new technologies.

Sometimes manufacturers’ representatives will have helpful documentation about the equipment or technique that you could use as a second resource. But don’t rely on the reps to assist you with the coding aspect of theservice. You also can turn to specialty societies for help with appeals and documentation.

Good practice:  When your otolaryngologist repeatedly performs the same type of unlisted procedure, prepare an information file so you don’t have to reinvent the wheel every time you submit a claim. Each time a carrier denies a similar claim, you will already have anappeals packet ready to send the payer to defend your claim.