Otolaryngology Coding Alert

Labyrinthotomy code applies to perfusion of steroid, not just gentamicin

Using 90772 instead of 69801 for a steroid injection can cut more than $685 from a claim. So you-d better know when each code applies.

See if your otology coding is up-to-date with this scenario offered by Gloria Sikora with Trinity Ear Nose & Throat Clinic in Tyler, Texas. An otolaryngologist gave a transtympanic injection of a steroid for sudden hearing loss. -Due to health problems, the patient was unable to be treated by conventional methods,- Sikora says. The physician made no incision in the eardrum. -How would you code this?- she asks. Extend 69801 to Steroid TM Injections Our experts say you should code a transtympanic (TM) injection of drugs, such as steroids, with 69801 (Labyrinthotomy, with or without cryosurgery including other nonexcisional destructive procedures or perfusion of vestibuloactive drugs [single or multiple perfusions]; transcanal). -Code 69801 applies to perfusion treatment of the inner ear,- says Hayes H. Wanamaker, MD, chief of otolaryngology at Crouse Hospital in Syracuse, N.Y. 

Historically, 69801 has applied to gentamicin injections for Meniere's disease (386.00-386.04). But the code also applies to steroid injections for Meniere's disease, autoimmune inner ear disease, and sudden hearing loss. -The Association of Otolaryngology Administrators states that the drugs include anti-inflammatory steroids (such as depomedrol, solumedrol, Decadron) and aminoglycosides (such as gentamicin, streptomycin, etc.) based on the code description of vestibuloactive drugs,- says Lynda Wright, physician billing manager at the Vanderbilt Bill Wilkerson Center for Otolaryngology and Communication Sciences in Nashville, Tenn. -We mostly infuse dexamethasone, which falls into the category of anti-inflammatory steroids,- she adds. Sidestep Myringotomy Pitfall Be careful that you don't code steroid perfusion as a myringotomy (69421, Myringotomy including aspiration and/or Eustachian tube inflation), says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J. Otolaryngologists may administer steroids via a myringotomy with or without a tube, or via needle injection, but you should report these as TM perfusions using 69801. Report Global Code Without 52 When reporting a TM injection of a steroid, do not attach modifier 52 (Reduced services) to 69801. The code does not require surgical labyrinthectomy. -Intratympanic administration (injection into the middle ear space) of aminoglycosides - is an alternative to surgical labyrinthectomy and vestibular nerve section for the treatment of refractory vertigo associated with Meniere's disease,- according to The Regence Group (Part B Medicare carrier for Idaho, Oregon, Utah and Washington) medical policy -Intratympanic Aminoglycoside and Corticosteroid Treatment for Meniere's Disease.- Chemical labyrinthectomy meets the criteria for using the full code without reduced services (modifier 52).

Key: To use 69801, the injection must be transtympanic. -The transtympanic perfusion of drugs procedure, [...]