Otolaryngology Coding Alert

Question: A patient complaining of dizziness is scheduled for a labyrinthectomy but is unable to undergo the procedure for medical reasons. Instead, the patient sees the otolaryngologist in the office for an injection of gentamicin to destroy the nerve for balance. The physician sees the patient two or three times a week. Do we bill for an office visit, or is there a specific code we can use?
      
Ohio Subscriber
 
Answer: The correct code is 69801 (labyrinthotomy, with or without cryosurgery including other nonexcisional destructive procedures or perfusion of vestibuloactive drugs [single or multiple perfusions]; transcanal). This service is usually provided in multiple treatments, all of which are included in the code, which may be billed only once. Office visits and injections are also included in 69801, which has a 90-day global period and has been assigned 17.48 transitioned RVUs in the CMS fee schedule.
 
A separate office visit can be billed (appended with modifier -25, significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) only if the patient has another problem unrelated to the dizziness that prompted the gentamicin injection. Any audiology or ENG (electronystagmography) testing performed during the visit should be paid separately. Don't forget to bill for the gentamicin supply using HCPCS code J1580 (injection, Garamycin, gentamicin, up to 80 mg).

Reader Questions and You Be the Coder were answered by Randa Blackwell, a coding specialist with the department of otolaryngology at the University of Maryland in Baltimore; Susan Callaway, CPC, CCS-P, a coding and reimbursement specialist and educator in North Augusta, S.C.; Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a physician billing firm in Lakewood, N.J.; Lee Eisenberg, MD, an otolaryngologist in private practice in Englewood, N.J., and a member of CPT's editorial panel and executive committee; and Teresa Thompson, CPC, an otolaryngology coding and reimbursement specialist in Sequim, Wa.