Otolaryngology Coding Alert

Answer: No CPT code exists for canalith repositioning, which is used to treat patients who have benign paroxysmal positional vertigo (BPPV). Therefore, reimbursement is carrier-specific.

Most private payers and Medicare consider the canalith repositioning procedure (CRP) part of the examination. For these carriers, include the work for CRP when determining the E/M service level, such as 99212 (Established patient office visit). Also, include the work performed for any other separately uncovered services, such as the Dix-Hallpike test, which is used to diagnose BPPV, in the E/M service for that day.

Some Medicare carriers, such as Empire Medicare Services (New York and parts of New Jersey) and Georgia Medicare, allow 92599 (Unlisted otorhino-laryngological service or procedure) for CRP. If your Medicare carrier policy allows 92599, note the description "canalith repositioning procedure" in item 19 of the CMS form or the electronic claim's free form line. Check if the carrier restricts billing an E/M service on the same day as CRP.

For private payers, copy the Medicare instructions onto your doctor's letterhead and include it with the claim and any appeals, says Barbara Cobuzzi, MBA, CPC, CPC-H, president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J. See page 87 for the form letter.