Otolaryngology Coding Alert

S9092 or even an E/M service is sometimes an acceptable option to 92700

Although no specific code exists for the canalith repositioning procedure (CRP), you can ease your reimbursement headaches with the following recommendations.

1. Usually Report 92700 for CRP

Because CPT doesn't contain a code for CRP, you should assign unlisted-procedure code 92700 (Unlisted otorhinolaryngological service or procedure) for the procedure, says Marla K. Dumm, CPC, coding specialist at Wichita Clinic's coding department in Wichita, Kan. Make sure you don't use deleted unlisted-procedure code 92599 (Unlisted otorhinolaryngological service or procedure), which coders reported prior to 2003. CPT 2003 deleted 92599 and replaced it with 92700.
 
Although most insurers accept 92700 for the maneuvering system, also called the Epley maneuver, some payers require a HCPCS code, says Gregory L. Schnitzer, RN, CPC, CPC-H, CCS-P, coding compliance and quality assurance manager for CodeRyte in Bethesda, Md. For instance, First Coast Service Options Inc. wants CRP providers to use HCPCS code A9270 (Noncovered item or service) to report CRP services, he says.
 
Wellmark Blue Cross Blue Shield (BCBS) of Iowa and South Dakota recommends S9092 (Canolith repositioning, per visit), which HCPCS introduced in 2003 as a temporary national code (non-Medicare). Wellmark's policy instructs providers to bill S9092 when CRP is the only service that the physician provides.
 
Otherwise, Wellmark's policy states that you should bill the appropriate-level E/M code, which includes CRP. Other ENT coding experts suggest bundling the procedure into the day's documented E/M service as an alternative to using unlisted-procedure code 92700.
 
Although HCPCS designates the S codes as BCBS and Health Insurance Association of America (HIAA) codes, not all BCBS policies advise using the temporary national code. Arkansas BCBS recommends using S9092, but other insurers may not adhere to this policy.
 
To avoid denials from payers that require alternative coding, check with insurers for individual policy requirements, Schnitzer says. In the absence of any such payer-specific policy, you should apply standard CPT coding guidelines (92700).

2. Submit Supporting Documentation

Whenever you report an unlisted-procedure code to describe a procedure or service, you need to submit supporting documentation, such as a procedure report, with the claim. The same rule holds true when filing 92700 for CRP. Make sure you provide an adequate description of the nature of, extent of and need for the procedure, as wel as the time, effort and equipment necessary to provide the service, Schnitzer says. "Reimbursement for this service will vary depending upon the payers' policies."
 
Dumm has had fairly good luck with reimbursement for the repositioning system in her region. "We have not had any consistent denials of this procedure code," she says.
 
Helpful hint: Dumm suggests the following method for recouping CRP payment without having to submit documentation. At Wichita Clinic (five otolaryngologists), the coders set up 92700 with an internal modifier that automatically inserts a description on the claim. "This has helped to facilitate first-pass payment, rather than having to explain what the code is and submit paperwork for each charge," she says. 

3. Check Payer Medical-Necessity Requirements

Many insurers require a diagnosis of benign paroxysmal positional vertigo (BPPV) (386.11, Vertiginous syndromes and other disorders of vestibular system; other and unspecified peripheral vertigo; benign paroxysmal positional vertigo) to support CRP. Otolaryngologists often diagnosis BPPV using the Dix-Hallpike maneuver (also called Nylen's maneuver or Barany's maneuver), Schnitzer says. Once the physician diagnoses BPPV, he or she may treat the condition using CRP or the Epley maneuver. (A similar maneuver exists called the Semont or Parnes maneuver that is not generally favored in the United States, he says.)
 
Some carriers require notes to demonstrate medical necessity and support the therapeutic service, Dumm says. Some may require a BBPV diagnosis prior to CRP coverage or a positive Hallpike test. Other insurers will pay for claims with the presenting symptoms, such as severe vertigo (780.4, General symptoms; dizziness and giddiness [vertigo NOS]), dizziness (780.4), and/or tinnitus (388.30, Other disorders of ear; tinnitus, unspecified), she says.