Otolaryngology Coding Alert

Question: I have been getting denials for labyrinthotomy by Decadron injection from one of our HMOs. The payer says 69801 is not allowed at the office (POS code 11). After I appealed and showed proof that Medicare pays for this procedure in the office, the HMO said that a nurse of 19 years experience has looked at this and she said the procedure should not be allowed in the office. They say we should use a different code. How can we straighten this out? New York Subscriber Answer: Youre coding correctly. Unfortunately, Medicare incorrectly considers 69801 (Labyrinthotomy, with or without cryosurgery including other nonexcisional destructive procedures or perfusion of vestibuloactive drugs [single or multiple perfusions]; transcanal) rarely performed in the office. Column H of the Medicare Physician Fee Schedule designates 69801 as NA, which means this procedure is rarely or never performed in the nonfacility setting. However, for treatment of [...]