Otolaryngology Coding Alert

These 5 secrets will help you obtain Epley maneuver pay

If you-re having trouble receiving payment for the Epley maneuver, you-re not alone. Fellow coders have tried numerous strategies and have come up short on paid claims. These tips will help you tackle coding this procedure.

1. Recognize Alternative Names for Epley Procedure

The Epley maneuver can masquerade as several terms, including the canalith repositioning maneuver/procedure (CRP) and liberatory maneuvers. -John Epley (1973) developed the Canalith Theory as the cause for 386.11 and developed the canalith repositioning maneuvers for treatment of benign paroxysmal positional vertigo,- according to the -Epley Maneuver Update- in the March 2006 edition of Pinnacle Medicare Providers- News.
 
2. Medicare Advice: Use Unlisted-Procedure Code

If, however, you look up any of the above terms in the CPT manual, your search will prove fruitless. -There is no specific code for - the Epley maneuver,- states Aetna's Clinical Policy Bulletin on Chronic Vertigo, dated Aug. 15, 2006.

Main option: Many carriers advise coding the Epley maneuver using an unlisted- procedure code. -Our Medicare carrier [Empire NY and HGSA NJ] specifically told us to use 92700 and put -Canalith repositioning- in box 19 of the claim,- says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J. This advice applies to numerous states including Pinnacle -- Part B carrier for Arkansas, Louisiana, Missouri, New Mexico, Oklahoma and Rhode Island.

Payment: Because 92700 is for an unlisted otorhinolaryngological service or procedure, the National Physician Fee Schedule designates the code as carrier-priced. -It pays around what a 99212 pays- (about $38.66 using the 2006 conversion factor of 37.8975 x 1.02 total nonfacility relative value units for 99212), Cobuzzi says.

Don't fret if your EOBs that involve an office visit and an Epley maneuver show no payment on the procedure. -When performed during an E/M service, the Epley maneuver is bundled in the E/M service,- states the August 2005 Pinnacle Medicare Providers- News.

3. Obtain Exceptions in Writing

Some insurers may want alternative codes for the Epley maneuver. Options that have been suggested over the years include:

- 98925 -- Osteopathic manipulative treatment (OMT); one to two body regions involved

- 97110 -- Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility

- 97112 -- - neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities

- 92599 -- Unlisted otorhinolaryngological service or procedure

- S9476 -- Vestibular rehabilitation program, non-physician provider, per diem.

Use these codes if you have those instructions in writing. These policies may be outdated and a throw back to pre-Medicare local guidance.

For instance, when Christina M. Grimes with DGC Services Inc. started coding for Peninsula ENT and Plastic Surgery, the practice had an S code (S9092, Canolith repositioning, per visit) on its routing slips. -We are not being paid when we use this code,- says Grimes, who is the owner/president of the Charleston, S.C.-based medical billing and collection company.

4. Apply Outdated AMA Advice to 92700

Official guidelines, however, do exist for the Epley maneuver. The AMA has clarified that CPT code 92599 should be used to report a canalith repositioning procedure, writes Gregory L. Schnitzer, RN, CPC, CPC-H, CCS-P, in -White Papers: The Canalith Repositioning Procedure (CRP)- published in the American Academy of Professional Coders- November/December 2001 issue of Coding Edge.

Problem: When the AMA's instruction came out, the CPT code for an unlisted otorhinolaryngological service or procedure was 92599, Cobuzzi says. -Code 92599 has since changed to 92700.-

5. Submit Procedure Description to Combat Denials

Because 92700 is an unlisted-procedure code, you may need added ammunition to obtain payment for the Epley maneuver. -We attach a copy of the procedure's description to the HCFA-1500 claim form,- says Bobby Jo Bachand, appeals coordinator at Capital Region Otolaryngology in Albany. N.Y. For one to include, see -Educate Insurer to Prevent Denials of Epley Maneuver- on page 83.