Otolaryngology Coding Alert

Question: How should we code laser-assisted uvulopalatoplasty (LAUP) on sleep apnea patients?

Arkansas Subscriber  
Answer: Medicare does not consider LAUP a covered service. In a local medical review policy similar to many nationwide, Wisconsin Physicians Service (Part B carrier in Illinois, Michigan, Minnesota and Wisconsin) states: LAUP is not a covered service and is not to be billed to Medicare as CPT code 42145 (Palatopharyngoplasty [e.g., uvulopalatopharyngoplasty, uvulopharyngoplasty]). This procedure can be billed for denial, using the CPT code 42299 (Unlisted procedure, palate, uvula). A description of the procedure should be placed in box 19, i.e., LAUP or laser-assisted uvulopalatoplasty. When LAUP is performed on a Medicare patient, a signed waiver should be obtained to prove the patient knows the procedure is not covered. Private payers are a different matter.
 
Many commercial carriers cover LAUP for sleep apnea patients; however, the only CPT code that comes close to describing LAUP (42145) is appropriately used for uvulopalatopharyngoplasty, a more complex procedure that also involves repairing the pharynx. With LAUP, only the palate and uvula are affected. As its descriptor indicates, 42145 may be reported for procedures that do not involve the palate; however, if the pharynx is not included (as is the case with LAUP), a lesser procedure must be reported. Since there is no other available code, -52 (Reduced services) should be appended to 42145 to indicate that pharyngoplasty was not performed.