Medicare Compliance & Reimbursement

Plus: Several new surgical codes debut, but it's which codes are missing from CPT 2009 that's got coders talking.

Don't let coding the Epley procedure make you dizzy anymore. CPT 2009 lends assistance with a new code effective Jan. 1.
Practices that treat patients for dizziness may perform canalith repositioning, also known as the Epley procedure. CPT never offered a code for this service before, but now provides one with 95992 (Canalith repositioning procedures [eg, Epley maneuver, Semont maneuver], per day).

"There has long been a debate about whether practices should use an unlisted code or a physical therapy code for this service," says Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, president of CRN Healthcare Solutions, senior coder and auditor for The Coding Network, and past member of the AAPC National Advisory Board.

"The new code will definitely eliminate that confusion. Anyone in an otolaryngology practice with a well established audiology department will be thrilled to have this new code for treating dizzy patients," Cobuzzi says.

Neurosurgery Scores New Codes

Otolaryngologists aren't the only specialists to benefit from new CPT codes. Spine surgeons will find the following three cervical disc replacement codes:

• 22856 -- Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection), single interspace, cervical
• 22861 -- Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical
• 22864 -- Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical

Orthopedics: Orthopedic surgeons may find use for one of the following new codes as well:

• 20696 -- Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (e.g., spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)
• 20697 -- ...exchange (i.e., removal and replacement) of strut, each

Outcome: Despite the addition of these codes, most orthopedic coders expressed disappointment rather than joy when CPT 2009 was unveiled.
 "I have to use unlisted codes so often," says Leslie Follebout, CPC-ORTHO, PCS, coding department supervisor with Peninsula Orthopaedic Associates. However, Follebout says, CPT 2009 won't alleviate her need for frequent unlisted coding because it failed to produce new codes for procedures such as hip scopes, arthroscopic tennis elbow repair, arthroscopic hardware removal, and other procedures. "I probably won't use the new orthopedic codes because our practice does not perform those services," she says.

General surgery: Gastro-enterologists and general surgeons may cheer when they see the new laparoscopy codes, including the following:

• 43279 -- Laparoscopy, surgical; esophagomyotomy (Heller type), with fundoplasty, when performed
• 49654 -- Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); reducible. 

In total, six new laparoscopy codes were added for hernia repair, ranging from 49652 to 49657.