Otolaryngology Coding Alert

Tip: Watch for documentation of multiple symptoms over time.

Meniere’s disease can sometimes be misinterpreted or misdiagnosed because it usually manifests in conjunction with migraine and/or vertigo. Read on for the latest on correctly diagnosing and treating Meniere’s.

Know What’s Needed for Diagnosis

The otolaryngologist must have documentation of several conditions before diagnosing a patient with Meniere’s disease. Diagnosis requires:

• Two spontaneous episodes of vertigo (386.2, Vertigo of central origin), each lasting 20 minutes or longer
• Unilateral, low frequency hearing loss (389.8, Other specified forms of hearing loss) verified by a hearing test on at least one occasion
• Tinnitus (388.3x, Tinnitus) or aural fullness (388.8, Other disorders of ear)
• Exclusion of other known causes of these sensory problems such as infection or blockage.

“When an otolaryngologist is reviewing the patient’s history and medical notes, he’s looking for a history of unilateral hearing loss, roaring tinnitus (instead of ringing), and negative MRI for acoustic neuroma, to name a few things,” says Candace Ruffing, CPC, CPB, CENTC, of South Coast Ear, Nose and Throat and a member of the AAPCCA Board of Directors.

Vertigo note: “Vertigo episodes in a patient with Meniere’s disease last a minimum of 20 minutes and can last up to 24 hours,” Ruffing adds. “There currently are no guidelines for how close the episodes are together. Some patients’ episodes are days apart and others are months or even years apart.”

Migraine distinction: Watching for particular details in the physician’s notes can help distinguish Meniere’s disease from migraines. “Patients who suffer from migraines typically don’t have the unilateral hearing loss or the ‘roaring’ tinnitus,” Ruffing explains. “Migraine patients typically complain of clustered symptoms, but patients with Meniere’s typically have scattered symptoms.”

Watch for Codeable Diagnostic Tests

No single test gives a definitive diagnosis of Meneire’s disease, so physicians can only reach a diagnosis after ruling out all other causes of the patient’s symptoms. Once the physician suspects Meniere’s because of the patient’s medical history and physical examination, he might order one or several tests to confirm the diagnosis. These can include:

• Hearing assessment to determine how well the patient hears sounds of different pitches and volumes. Tests can also help determine if the source of hearing problem is in the inner ear or the nerve that connects the inner ear to the brain. Report the assessment with the appropriate code from 92557-92588.
• Balance assessment to check whether the patient experiences ongoing balance problems between vertigo episodes. Tests might include videonystagmography (VNG) (often reported with a vestibular function test code from 92540-92548); rotary chair testing (92546, Sinusoidal vertical axis rotational testing); vestibular evoked myogenic potentials (VEMP) testing (92585, Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive); or posturography (92548, Computerized dynamic posturography).
• EcoG (electrocochleography) to measure whether pressure is present in the inner ear (92584). “A well done EcoG test that shows high pressure supports a diagnosis of Meneire’s,” Ruffing says.

Any of these tests are codeable when your physician uses them to help establish a diagnosis of Meniere’s disease (386.0x). There currently are not any CCI edits in place that prevent you from coding multiple diagnostic tests during the same encounter. However, always watch for edits that might be implemented or payer guidelines that change how you should report the services.