Wiki Labyrinthotomy in office setting?

[kjferg47]

I have a physician who performs inner ear steroid injections in the office, per CPT the best code for this procedure is 69801 - Labyrinthotomy - CMS (and other carriers) considers this major surgery and will not pay for it (at least on first submission) with POS 11. I intend to appeal the decision and was hoping for some "tried and true" advice on what to write in the body of my appeal letter. Any assistance is greatly appreciated. Thanks

 

[FTessaBartels]

Here's the lay description

This is NOT my area of expertise ... but

Here's the lay description for 69801 ...
In a transcanal approach (69801), the physician makes an incision in the posterior ear canal skin through the external ear opening and reflects the skin flap and posterior tympanic membrane forward. For a mastoid approach (69802), the physician drills out the mastoid cavity. In either case, the posterior ear canal wall remains intact. The horizontal semicircular canal is visualized. Under microscopic guidance, a variety of procedures may be performed, including placement of a small, temporary or permanent tack through the stapes footplate; placement of a hook through the round window or ultrasonography or cryotherapy of the round window. In 69801, the canal is packed. In 69802, the mastoid cavity is packed and the incision is closed with sutures. (From Encoder Pr

I'm not seeing how an inner ear steroid injection meets the description for this code.

F Tessa Bartels, CPC, CEMC

 

[LadyT]

I have a physician who performs inner ear steroid injections in the office, per CPT the best code for this procedure is 69801 - Labyrinthotomy - CMS (and other carriers) considers this major surgery and will not pay for it (at least on first submission) with POS 11. I intend to appeal the decision and was hoping for some "tried and true" advice on what to write in the body of my appeal letter. Any assistance is greatly appreciated. Thanks

I can only tell you my pyhsician also does this in a office setting & I have never recieved a denial. They are even paid on first pay pass.