Otolaryngology Coding Alert

Answer: The Epley maneuver is a simple but time-consuming treatment for a certain form of vertigo (386.11, Benign paroxysmal positional vertigo) caused by small calcium carbonate stones that have moved from the vestibule of the inner ear into the semicircular canals, where your sense of balance rests. The stones stimulate nerves and cause a spinning sensation, nausea, and unsteadiness.

 

In the Epley, the patient’s head is maneuvered so the calcium crystals roll out of the sensing tube and into another inner chamber of the ear, from which the body can absorb them. Report 95992 (Canalith repositioning procedure[s] [e.g., Epley maneuver, Semont maneuver], per day) to describe the Epley. Medicare, however, considers the code as a bundled service.

 

Wrong provider: For years, audiologists have performed Epley maneuvers on patients who experience dizziness. But under Medicare, audiologists also cannot get paid for therapeutic procedures such as the Epley. Audiologists are only eligible for payment for diagnostic procedures. Because of this, make sure that your physician performs the Epley.

 

Coding tactic: If the local contractor (Medicare or non-Medicare) LCD has specifically stated that Epley is part of E/M and should not be reported separately, then you shouldn’t report the service. If the contractor does not have an Epley LCD, either report the code or write a query to the payer requesting written verification of how to report the two services. Standard CPT® rules should apply, unless the payer specifies otherwise. If your practice needs to track Epleys but must count them as part of E/M, create an internal code with a value of $0.