Practice Management Alert

Sinus implants also get a bump with a pair of ‘T’ codes.

Physician practices that perform vestibular tests or sinus implants will want to take note of some changes coming in the CPT^® 2016 manual.

While the majority of these changes will affect otolaryngology practices, it’s always good to know of coding changes in case your practice sees a patient needing one of these otolaryngology-centric services.

Take a sneak peek at the main changes affecting these otolaryngology procedures in 2016.

Overhaul Caloric Vestibular Test Choices

Physicians conduct a caloric vestibular test to evaluate whether there is something wrong with the vestibular (balance) portion of the patient’s inner ear. The test also evaluates areas of the brain that are involved with balance and can help isolate dizziness symptoms to a specific cause that might be treatable.

In the past, you’ve had a single procedure code to report for caloric vestibular tests. CPT^® 2016 will delete that familiar code — 92543 (Caloric vestibular test, each irrigation [binaural, bithermal stimulation constitutes 4 tests], with   recording) — in favor of two new codes:

• 92537, Caloric vestibular test with recording, bilateral; bithermal (i.e., one warm and one cool irrigation in each ear for a total of four irrigations)
• 92538, … monothermal (i.e., one irrigation in each ear for a total of two irrigations).

“With the current coding, practices have had a difficult time getting paid for the four units they bill for 92543 based on CPT^® code instructions,” says Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CENTC, CPCO, vice president of the coding and consulting division of J. & S. Stark Billing & Consulting, Inc., in Shrewsbury, N.J. “They often get paid for one unit. It appears that payment will be more accurate and less difficult to obtain with these two new codes since we won’t be fighting for units. We’ll either bill one unit of 92537 if the physician performs four irrigations, or one unit of 92538 if he completes two irrigations.”

Watch for Drug-Eluting Sinus Implant Usage

You’ll also find two new codes for placing a sinus implant, as follows:

• 0406T — Nasal endoscopy, surgical, ethmoid sinus, placement of drug eluting implant
• 0407T — … with biopsy, polypectomy or debridement.

Key differences: You would use these codes when your provider places PROPEL drug-eluting sinus implants during a separate encounter, not at the time of endoscopic sinus surgery. Codes 0406T and 0407T do not apply to the use of other stents, spacers, or packing materials. You should only consider reporting them for products approved by the FDA as “drug-eluting sinus implant” (PROPEL is the only one at this time).

When the provider performs the service described by 0407T, he removes tissue from the ethmoid sinus via biopsy, polypectomy, or debridement. The existing CPT^® codes that represent sinus tissue removal (31267, 31276, and 31288) are for the maxillary, frontal, and sphenoid sinuses. Now you’ll have a more accurate code to report when the ENT does a similar procedure in the ethmoid sinuses.

Say Goodbye to Category III and Guidance Codes

Practices that might perform otolaryngology procedures should also be sure to mark three code deletions system for 2016:

• 70373 — Laryngography, contrast, radiological supervision and interpretation
• 0240T — Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with high resolution esophageal pressure topography
• 0241T — … with stimulation or perfusion during high resolution esophageal pressure topography study (e.g., stimulant, acid or alkali perfusion) (List separately in addition to code for primary procedure).

Cobuzzi doesn’t believe most providers would use these codes; the first is a radiology code, and gastrointestinal (GI) specialists usually perform the other two procedures. Knowing about changes related to ENT care is always a good thing, however, in case you’re faced with an out-of-the-ordinary claim.