Otolaryngology Coding Alert

Warning: Medicare still won't reimburse audiologist-billed Epley.

ENT coders, you have reason to cheer. After two years of battles with CMS over canalith repositioning procedure (CRP) coding, physicians will finally get paid for these specific codes.

CPT 2009 excited ENT coders with new CPT code 95992 (Canalith repositioning procedure[s] [e.g., Epley maneuver, Semont maneuver], per day). The 2009 Medicare Physician Fee Schedule cut coders' applause short. CMS assigned the codes 'B' status or always bundled it, making payment for CRP or the Epley maneuver using the new code impossible to obtain.

The 2011 Medicare Physician Fee Schedule ends the fight for payment of CRP. At the beginning of next year, the codes status will be "A'", announced Marc Hartstein, deputy director of CMS' hospital ambulatory policy group. "We will finalize the proposal with a work RVU of 0.75 and the RUC recommended PE inputs." When 95992 had status B, ENTs were instructed to instead use an E/M code. Now, they'll be able to specifically code for the work of CRP with 95992.

Remember: If the ENT performs and documents a medically necessary E/M that is significant and separately identifiable from the CRP, append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service)  to the E/M service. In addition, Medicare does not allow payment for audiologists performing therapeutic procedures, such as CRP. Highlight This Time Clarification in Your CPT 2011 Manual All that fine green print on time in your E/M CPT 2011 manual boils down to one thing: you can round to the closest time code. But that advice from CPT contradicts Medicare's threshold time guideline.

CPT 2011 indicates you can use the code closest to the documented time. That advice is nothing new. "In selecting time, the physician must have spent a time closest to the code selected," states CPT Assistant, Aug. 2004.

Your documented time must equal or exceed the average time given to bill that level. For a 35 minutes spent on a medically necessary counseling-dominated visit is a 99214, per CPT you could report 99215.

Medicare Has Considered Times Thresholds

Medicare has always considered the times indicated in CPT's code descriptors to represent minimums. The physician would select the lower code (for instance 99214, ... physicians typically spend 25 minutes face-to-face with the patient and/or family ...) unless the time was greater than or equal to the higher-level code's required time (such as 40 minutes for 99215).

Will Medicare Change Its Position?

At the CPT and RBRVS 2011 Annual Symposium when questioned on whether Medicare would change the allotments from thresholds to averages, medical directors were reluctant to give a definitive answer. "I don't want to say one way either 'Yes' or 'No' at this time," said E/M expert Deborah Patterson, MD, clinical medical director for Trailblazer Health Enterprises, LLC in Dallas.