Otolaryngology Coding Alert

Say goodbye to those tricky temp or -S- codes. Jumping through the hoops to seek reimbursement for unlisted and experimental procedures is enough to make any coder dizzy. But CPT 2009 comes through for ENT coders with new codes, one of them a long-sought victory on the Epley maneuver, or canalith repositioning procedure (CRP). So give a big Coding Alert welcome to 95992 (Canalith repositioning procedure[s] [e.g., Epley maneuver, Semont maneuver], per day). Two procedures to treat obstructive sleep apnea have been added, too, one of which is a win for coders who-ve been slogging through with a temporary Category III code. CRP Finally Gets a Code Fixing dizziness: The Epley maneuver treats a form of vertigo -- 386.11 (Benign paroxysmal positional vertigo) -- that is caused by small calcium carbonate stones that have moved from the vestibule of the inner ear into the semicircular canals, where your sense of balance rests. The stones stimulate nerves and cause a spinning sensation, nausea, and unsteadiness. Sure beats surgery: The patient's head is maneuvered so the calcium crystals roll out of the sensing tube and into another inner chamber of the ear, from which they can be absorbed. To add to the confusion, sometimes the tiny stones are sometimes spelled "canolith," sometimes "canalith" -- and they may be called otoliths or cupuloliths. Old codes, old problems: In 2008, you have a HCPCS code: S9092 (Canolith repositioning, per visit). However, Medicare does not recognize the "S" HCPCS codes, so you shouldn't report them to Medicare. Most Blue Cross/Blue Shield and some other commercial payers will recognize the S codes, but such HCPCS codes have no established relative value units (RVU), so you may still encounter payment problems. The American Academy of Otolaryngology-Head and Neck Surgery recommended coding 92700 (Unlisted otorhinolaryngological service or procedure), which required coders to submit a description of the service with the claim. But Medicare wanted to see the phrase "canalith repositioning procedure," not the common "Epley maneuver," named after the procedure's inventor, Dr. John Epley. And some carriers and third party payers required the use of physical therapy (PT) codes when coding and billing for the Epley procedure, which created a whole new set of problems given the PT caps. None of that guaranteed success. Insurers just haven't been paying for the Epley, Peggy Brubaker, office manager at Andover Ear, Nose & Throat Center in Andover, Mass., says. Her coders tried 92700 to no avail. "So now they just bill an office visit code," she says. No more vertigo: "Now we no longer have this confusion on how to code this service -- 95992" said Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J. [...]