Otolaryngology Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: We have always performed the Epley maneuver at no charge, but now one of our otologists wants to charge for it. Is there a code we can use, and does Medicare reimburse for it?

Arkansas Subscriber
  Answer: There is no code for the Epley maneuver, also known as the canalith repositioning procedure.  Most Medicare Part B carriers do not cover the procedure, which is performed to free very small crystals of calcium carbonate located in the inner ear that are dislodged and float down to the inner-ear canals, where they become trapped. The Epley maneuver helps to clear the crystal from the canal and return it to where it originally came from.
 
Some Part B carriers pay for the procedure. For example, Empire Medicare Services , the Medicare carrier in New Jersey and parts of New York, and HGSA (the Part B Pennsylvania carrier) instruct physicians to bill for it using unlisted-procedure code 92599, with a short notation such as "canalith repositioning procedure" in the comments box of the claim form. The only diagnosis that may be payable, however, is benign paroxysmal positional vertigo, BPPV, 386.11.
 
Commercial payers may also pay for the tests, although precertification will likely be needed. Because policies range so widely, carriers, both Medicare and private, should be contacted, and, if possible, pre-authorization should be obtained in writing.