Otolaryngology Coding Alert

Ménière’s disease (H81.0-, Ménière’s disease …) is a disorder of the inner ear that causes spontaneous episodes of vertigo, fluctuating hearing loss, tinnitus, and a feeling of fullness or congestion in the ear. Approximately 615,000 U.S. residents are currently diagnosed with the condition. More than 500 oral and poster presentations about research covering all aspects of otolaryngology were shared during the 2015 Annual Meeting of the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) in September.

Findings from several research studies addressing various facets of Ménière’s disease treatment were available at the conference. These included:

• Questionnaires measuring patient perception of quality of life (QOL) before treatment and three months later. Most patients responded to medications used for migraine, and the vast majority (92 percent) reported an improved QOL. Researchers believe the study supported the notion that there is a significant overlap of Ménière’s disease and migraines (G43.---). They also concluded that the symptoms of Ménière’s disease could possibly be caused by a migraine etiology.
• Review of evidence for using oral diuretic medications to manage Ménière’s disease and analyze therapy-related hearing and vertigo outcomes. After examining articles from 11 different countries from 1962 to 2012, multiple low-evidence-level studies reported that oral diuretic therapy is beneficial in the medical management of Ménière’s disease. Improvement in vertigo episode frequency was consistently reported, with less convincing evidence for improvement in hearing outcomes.
• A study of the effectiveness of a new dexamethasone formulation to treat Ménière’s disease. Physicians routinely inject IV steroid solutions intratympanically as an off-label treatment of Ménière’s disease. The injections can be effective but need to be repeated because of limited cochlear exposure. This study analyzed the safety and efficacy of a single IT injection of OTO-14; a previous study of the formulation showed that OTO-14 reduced vertigo frequency and tinnitus incidence and severity after a single IT injection compared with placebo. Baseline data showed results comparable to the previous phase study.
• An evaluation of how effective on-demand intratympanic gentamicin can be in patients with intractable Ménière’s disease and the number of ITG doses required for vertigo control. Patients in the study had failed conventional treatments such as medical interventions and intratympanic dexamethasone injections.  Researchers concluded that on-demand ITG is effective, achieves vertigo control, and represents a nonsurgical alternative in patients with intractable Ménière’s disease. Vertigo recurrence post-ITG should be treated with subsequent on demand ITG applications. You report ITG injections with 69801 (Labyrinthotomy, with perfusion of vestibuloactive drug[s]; transcanal) plus the J code for Gentamicin.