Otolaryngology Coding Alert

Question: In the past, our Medicare contractor paid for the Dix-Hallpike diagnostic testing our audiologists performed, as long as we included the Dix-Hallpike descriptor in the narrative field of our electronic claim submission. We would report unlisted CPT® code 92700. Now the payer is denying the claims with code M51, Missing/incomplete/invalid procedure code.

When I called the payer, a rep told me that an “internal policy” change was sent out on this unlisted CPT® code in mid-June and claims processors were instructed to deny this code.  When I asked for a copy or information on this policy, I was told that since it is an “internal policy” they cannot give us any information on this denial.  To your knowledge, is there a more appropriate code to bill for this test?

Idaho Subscriber

Answer: Submitting 92700 (Unlisted otorhinolaryngological service or procedure) is your best option despite the denials you’re receiving.  

Payers often want extensive descriptions when they are paying on “unlisted” procedures since there is not a standard CPT® description specific to what you are coding and billing. The denial forces you to appeal every time your practice performs the Dix-Hallpike diagnostic test. 

Suggestion: Write up a template letter describing the procedure, what it is used for, and why it is necessary for the patient. You can edit it as necessary to be specific for each patient and send in the appeal for each denial. Going through this process takes more effort on your part and makes it take longer for you to get paid, but this is how the third party payer insures that they do not pay for services that they don’t cover. This is not to say that the Dix-Hallpike is not covered, but there are instances when third party payers have improperly paid for services based on improper descriptions put in Box 19 of a CMS1500 form. This is how the payer is protecting themself and putting all of the burden on you to fight for payment.