Otolaryngology Coding Alert

Question: I am looking for a CPT code to describe a procedure we do in our office called the canalith repositioning (Epley maneuver) for benign positional vertigo (386.11). We have been told to use 97140 (manual therapy techniques [e.g., mobilization/manipulation, manual lymph-atic drainage, manual traction], one or more regions, each 15 minutes), which is not really the correct procedure being done, but seems to be the closest CPT code we can use. Reimbursement is not very high, so we would like to find a better and correct CPT code. What code should we use?

Kathy Siano
Fort Myers, Fla.

Answer: In patients with benign paroxysmal positioning vertigo, or BPPV (386.11), very small crystals of calcium carbonate located in the inner ear are dislodged and float down into one of the three canals of the inner ear, where they are trapped. When the person moves a certain way, the crystals move and give the person a spinning sensation. Both the test for BPPV (known as the Dix-Hallpike test) and the procedure most often used to treat it (canalith repositioning procedure or CRP) are not covered by some Medicare carriers.

Canalith repositioning is used to clear the crystal out of the canal and deposit it back into the part of the inner ear where it belongs. As the reader indicates, it has no CPT code. Although Medicare policies vary from carrier to carrier, some, such as Xact Medicare Services, the Medicare carrier in Pennsylvania, pay for the procedure. According to an Xact Medicare Report from September 1998, Since the CRP is considered to be a safe and effective treatment for BPPV, Medicare will cover this procedure for this condition. Use procedure code 92599 (unlisted otorhinolaryngological service or procedure) to report CRP, and include the narrative Canalith Repositioning Procedure. Xact goes on to note Claims for CRP reporting a diagnosis other than BPPV will be denied.

Some private carriers also may pay for the tests, though they may require prior authorization. Because policies differ from payer to payer, you should contact your carrier to determine their specific policy on this service.