Otolaryngology Coding Alert

Question: I have a question about Gentamicin injections. Do you bill the full vial amount the first time, or bill the amount injected each time the patient comes in? This is being billed with 69801, which I know has a 90 day global, and I can't bill during the global, but how do I code the drug?

Utah Subscriber

Answer: Because 69801 (Labyrinthotomy, with or without cryosurgery including other nonexcisional destructive procedures or perfusion of vestibuloactive drugs [single or multiple perfusions]; transcanal) has a 90-day global period, all three injections are included in the billing of 69801 when it is billed the first time. You would not report 69801 again during the global period. Instead, you just bill the subsequent medication at each subsequent visit. You may have to appeal a denial due to the claim not having a matching administration code with an explanation showing that the injection was included in the first visit.

The code for the medication is J1580 (Injection, garamycin, gentamicin, up to 80 mg). Labyrinthotomy treats severe cases of vertigo, sometimes seen in patients with Ménière's disease (386.00, Ménière's disease, unspecified). Several injections, usually done weekly over a period of time, are given in the inner ear. The gentamicin deadens the hair-like fibers that transmit balance information to the brain. Initially, the injections may cause extreme dizziness for several days or weeks. This eventually dissipates and the vertigo disappears.

-- Answers to You Be the Coder and Reader Questions provided/ reviewed by Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPCI, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J.