Otolaryngology Coding Alert

Question: I have been getting denials for labyrinthotomy by Decadron injection from one of our HMOs. The payer says 69801 is not allowed at the office (POS code 11). After I appealed and showed proof that Medicare pays for this procedure in the office, the HMO said that a nurse of 19 years experience has looked at this and she said the procedure should not be allowed in the office. They say we should use a different code. How can we straighten this out?

New York Subscriber

Answer: Youre coding correctly. Unfortunately, Medicare incorrectly considers 69801 (Labyrinthotomy, with or without cryosurgery including other nonexcisional destructive procedures or perfusion of vestibuloactive drugs [single or multiple perfusions]; transcanal) rarely performed in the office. Column H of the Medicare Physician Fee Schedule designates 69801 as NA, which means this procedure is rarely or never performed in the nonfacility setting.

However, for treatment of severe cases of vertigo, an injection of gentamicin is a common procedure performed in an otolaryngologists office, the American Academy of Otolaryngology-Head and Neck Surgery says. Download the AAOs position on 69801 at www.entnet.org/Practice/upload/gentamicinInjections.pdf.

What you can do: Ask that a board-certified otolaryngologist, not a nurse, review the appeal. Copy your state attorney general and the N.Y. Medical Society on the claim. A nurse is not licensed to practice medicine, and you need a board-certified otolaryngologist for this specialized procedure.

Dont forget: When reporting 69801 for a Decadron injection performed in the office, you should also bill for the drug. Code 69801 represents the infusion. For the Decadron, use J1100 (Injection, dexamethasone sodium phosphate, 1 mg).

Remember: Because of 69801s 90-day global period, include all three injections that the otolaryngologist gives in the coding of the first injection, and then bill the subsequent medication only.