Otolaryngology Coding Alert

Unfortunately, most private and Medicare carriers do not accept these codes for canalith repositioning, says Lee Eisenberg, MD, an otolaryngologist in private practice. Nor do most carriers cover the Dix-Hallpike test separately, he adds. Rather, they consider the test part of the patient examination.

"What this means is that, at most, the otolaryn-gologist may be able to boost the level of E/M services provided during the visit, as the examination, and possibly the medical decision-making, may be increased," Eisenberg says.

But at least two commercial payers Blue Cross & Blue Shield (BC/BS) of South Dakota and Regence, the BC/BS carrier in Idaho, Oregon, Utah and Washington instruct providers to report the Dix-Hallpike test with 92532 (Positional nystagmus test).

Policies for the canalith repositioning are just as varied. Some carriers, such as First Coast Service Options, the Part B carrier in Florida, and Trailblazer Health Enterprises, the Part B carrier in Texas, do not cover canalith repositioning, stating, "This procedure is not considered the standard of practice." First Coast instructs providers to code the service using A9270 (Noncovered item or service), and Trailblazer instructs carriers to obtain a waiver before billing patients for the service. Other carriers, such as Georgia Medicare; HGSA, the Part B carrier in Pennsylvania; and Empire Medicare Services, the Part B carrier in New Jersey and parts of New York, cover canalith repositioning for BPPV only.

These payers instruct otolaryngologists: "When submitting claims to Medicare for the canalith repositioning maneuver, bill 92599 (Unlisted otorhinolaryngological service or procedure). The description 'canalith repositioning maneuver' must be stated in item 19 of the 1500 claim form or on the free form line of electronic claims. Reimbursement will be equivalent to a 99212 service."

Some private carriers, such as Regence BC/BS, also cover the service, instructing physicians to report it with unlisted-procedure code 92599.

Although CRP is covered, you should not always report it separately. For example, in its local medical review policy (LMRP) on canalith repositioning, South Dakota BC/BS first states that "canalith repositioning treatment for BPPV is considered a covered benefit."

However, the LMRP states: "Canalith repositioning treatment is considered a part of the evaluation and management procedure code. Providers should bill an appropriate level of E&M code to reflect the resources used to provide this service. Any other procedure used with the E&M code will be denied as incidental service." Although it is a covered service, it should not be reported separately but should be included as a part of the entire E/M service provided by the otolaryngologist.

Given the wide variation in coverage and payment policies, otolaryngologists are strongly recommended to contact their carriers for specific guidelines, says Susan Callaway, CPC, CCS-P, a coding and reimbursement specialist and educator in North Augusta, S.C., adding that whenever possible, a preauthorization of payment (in writing) should be obtained.

Callaway says that payment may be simplified if the visit for canalith repositioning is billed as 99212 (Established patient, office visit), as long as the otolaryn-gologist reviews (and documents) the patient's history to make sure the diagnosis is BPPV and then performs medical decision-making (MDM) by discussing the procedure, any expected results, or possible complications with the patient.

"A physical examination is not necessary because only two of the three components that make up an E/M visit history, exam and MDM are required for an established patient visit," Callaway adds.

Note: Most carriers do not cover the use of CRP for any diagnosis other than BPPV.