Otolaryngology Coding Alert

See what previously unlisted services now have a home in the CPT^® manual.

While the monumental changes to the evaluation and management (E/M) landscape are stealing all the headlines, you’ll want to be sure to reserve plenty of room and energy to digest the rest of the new, revised, and deleted CPT^® codes coming your way in 2021. Fortunately, otolaryngology is only modestly affected by a series of new codes spanning the Respiratory System, Auditory System, and Special Otorhinolaryngologic Services and Procedures subsections.

Among other important additions, CPT^® 2021 includes a new set of eustachian tube dilation (ETD) and nasal wall implant codes that you can use in place of previously required unlisted codes.

Read on to get some detailed knowledge on these respective changes and more coming your way in 2021.

See Coding Breakdown for Nasopharyngoscopy ETD, Nasal Valve Collapse Repair

To start, have a look at a new code you’ll report for nasal valve collapse repairs that involve lateral wall implants:

• 30468 (Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant(s))

This relatively modern procedure involves an incision into the nasal mucosa and subsequent placement of a polymer implant using a cannula. You may recall reading about the Latera^® absorbable nasal implant procedure in the Otolaryngology Coding Alert (v20n1) article titled “Learn the Coding Fundamentals Behind this New Nasal Implant Procedure.” In this article, the coding guidance advises that for lack of a more applicable code, you report this service using unlisted code 30999 (Unlisted procedure, nose).

Fortunately, the Latera^_® absorbable nasal implant and other similar surgical procedures involving subcutaneous/submucosal lateral wall implants now have a code they can call home with 30468.

Next, you’ll want to address a set of two new nasopharyngoscopy codes in the Respiratory System subsection:

• 69705 (Nasopharyngoscopy, surgical, with dilation of eustachian tube (ie, balloon dilation); unilateral)
• 69706 (…bilateral)

Similar to Latera^®, you can refer to a previous Otolaryngology Coding Alert (v20n7) article titled “Rely on Unlisted Code, Accurate Comparison to Report AERA^® ETD System,” in which we explain that you should resort to code 69799 (Unlisted procedure, middle ear) for treatment of persistent ETD using the Acclarent AERA^® ETD System. Ronda Tews, CPC, CHC, CCS-P, AAPC Fellow, director of billing and coding compliance at Modernizing Medicine in Boca Raton, Florida, chimes in to offer some important insight and historical context into to the challenges coders faced billing for ETD services prior to 2021.

“As early as Sept. 2016, the FDA allowed marketing of balloon dilation for ETD. This was followed up in 2017 with the FDA granting clearance to Entellus Medical (now owned by Stryker) for the XprESS^® ENT Dilation System. Soon thereafter came FDA approval for the AERA® ETD System in early 2018,” Tews details.

However, coders and physicians struggled in the subsequent years with the underlying question of how to properly bill for these services. While code C9745 (Nasal endoscopy, surgical; balloon dilation of eustachian tube) fits the mold, HCPCS Level II C codes are exclusively designated for Outpatient Prospective Payment System (OPPS) billing. Furthermore, despite payers and device manufacturers recommending unlisted code 69799, reimbursement was never a sure thing. “Otolaryngology practices will now be pleased to hear that nasopharyngoscopy with dilation of eustachian tube(s) codes 69705 and 69706 will go into effect Jan. 1, 2021,” says Tews.

Consider New Codes for VEMP, Auditory Evoked Potential Services

Finally, make your way toward the Special Otorhinolaryngologic Services and Procedures subsection and consider this brand-new series of vestibular and auditory evoked potential codes:

• 92517 (Vestibular evoked myogenic potential (VEMP) testing with interpretation and report; cervical)
• 92518 (…ocular (oVEMP))
• 92519 (…cervical (cVEMP) and ocular (oVEMP))
• 92650 (Auditory evoked potentials; screening of auditory potential with broadband stimuli, automated analysis)
• 92651 (Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report)
• 92652 (Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report)
• 92653 (Auditory evoked potentials; neurodiagnostic, with interpretation and report)

With respect to code range 92517-92519, the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS) defines VEMP as a useful neurophysiologic test “in the evaluation of certain persons with suspected auditory and balance or dizziness disorders.” Specifically, VEMP testing allows the audiologist, or neurologist, to detect the response of specific muscles when sounds reach the inner ear. To summarize each test: cVEMP testing measures responses from the sternocleidmastoid via the bony area behind the ear, the collarbone, or the breastbone; while oVEMP measures responses in the inferior oblique muscle within the eye socket.

On the other hand, code range 92650-92653 is used more traditionally for audiometry testing within audiology practices. While your current auditory evoked potential code range is limited to 92585-92586, you’ll now have the option to report tests involving screening of auditory potential, hearing status, and threshold estimation that utilize broadband stimuli. Broadband stimuli differs from traditional auditory testing stimuli in that it includes clicks, noises, amplitude modulated noise, and even chirps of varying frequencies. Neurodiagnostic auditory evoked potentials measure electrical signals produced by the nervous system in response to transient acoustic stimulus.