Wiki Labyrinthotomy in office setting? - ear steroid injections

[kjferg47]

I have a physician who performs inner ear steroid injections in the office, per CPT the best code for this procedure is 69801 - Labyrinthotomy - CMS (and other carriers) considers this major surgery and will not pay for it (at least on first submission) with POS 11. I intend to appeal the decision and was hoping for some "tried and true" advice on what to write in the body of my appeal letter. Any assistance is greatly appreciated. Thanks

 

[RebeccaWoodward*]

Hmmm..Not my area of expertise (69801) but I don't see a fee schedule for non-facility (11). Makes me wonder if Medicare will pay for this in a phyician's office.

 

[kjferg47]

Thanks again, Rebecca. I checked the NGS fee schedule and found a fee of $805.90 for the 69801 with no alternate fees. Where did you not see a fee for this service for non-facility? I also checked my customcoder account and did not find anything to state that this procedure was POS specific - if you are in fact correct I need to know what I'm doing wrong.

 

[RebeccaWoodward*]

http://www.cms.hhs.gov/pfslookup/02_PFSsearch.asp

Select pricing information-
Next-
I selected Nation but you can narrow it down to your region
Next-
Enter CPT code
Select all modifiers on your drop down key
submit

 

[kjferg47]

Is there anything you don't know?? Yet another useful toy to play with and keep my head spinning.

Thanks
Ken