Otolaryngology Coding Alert

Otolaryngologists frequently use canalith repositioning to treat patients with benign paroxysmal positional vertigo (BPPV). No code exists for this procedure or for the test that diagnoses BPPV, and obtaining reimbursement is entirely carrier-specific. Patients with BPPV have dizziness because tiny pieces of calcium carbonate in the inner ear become dislodged and are trapped in one of three canals inside the inner ear. Certain moves by the individual then result in a spinning sensation, or vertigo.

To determine if BPPV is the cause of the dizziness, the otolaryngologist performs the Dix-Hallpike test, a noninvasive study that involves moving the patient rapidly from a sitting to a supine position with the head tilted so that the ear is below the horizontal plane. If nystagmus and vertigo are observed, the test is considered positive. Once a diagnosis of BPPV (386.11) has been established, the otolaryngologist will likely treat the patient by performing the canalith repositioning procedure (CRP). With this technique, the otolaryngologist tries to reposition the loose crystals so they become stationary. Treatments may need to be repeated before the symptoms are resolved. Note: The canalith repositioning procedure is sometimes referred to as the Epley maneuver, but the two terms are not synonymous. Although the Epley maneuver is most commonly used to reposition the canaliths, another maneuver, known as the Semont, or liberatory maneuver, may be performed instead. The generic term for the service, therefore, is the canalith repositioning procedure. Coding the Procedures Individual carriers have specific payment policies and coding requirements for both services that can vary dramatically. For example, the American Academy of Otolaryn-gologists-Head and Neck Surgeons suggests using the following codes for the canalith repositioning procedure:

CPT 97112 Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities

CPT 97140 Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes

CPT 97530 Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes.
Unfortunately, most private and Medicare carriers do not accept these codes for canalith repositioning, says Lee Eisenberg, MD, an otolaryngologist in private practice. Nor do most carriers cover the Dix-Hallpike test separately, he adds. Rather, they consider the test part of the patient examination.

"What this means is that, at most, the otolaryn-gologist may be able to boost the level of E/M services provided during the visit, as the examination, and possibly the medical decision-making, may be increased," Eisenberg says.

But at least two commercial payers Blue Cross & Blue Shield (BC/BS) of South Dakota and Regence, the BC/BS carrier in Idaho, [...]