The Latest on the New Epley Maneuver CPT Code

Posted on 24. Apr, 2009 by Editor in Hot Coding Topics

Medicare slaps ‘bundled’ status on 95992, denies reimbursement for new code.

In January, you finally got a code to describe the Epley maneuver, a simple but time-consuming treatment for a type of dizziness. But now you’re having even more trouble getting paid for the work.

The Epley maneuver treats a form of vertigo (386.11, Benign paroxysmal positional vertigo) that is 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.

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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.

The way it was: For years, CPT didn’t have a dedicated code for the procedure, but at least some coders had success using 92700 (Unlisted otorhinolaryngological service or procedure). “Prior to October, our office had not had any problems getting paid for the Epley,” says Candice Ruffing, CPC, CENTC, who codes for Drs. Berghash, Lanza & Zeiders in Port St. Lucie, Fla. “In field 19A [of the CMS 1500] we would enter the description ‘canalith repositioning maneuver.’”

And now: The AMA brought out a new code 95992 (Canalith repositioning procedure[s] [e.g., Epley maneuver, Semont maneuver], per day) to describe the Epley. (See Otolaryngology Coding Alert, Vol. 10, No. 12) Trouble is, Medicare denies payment for it. “Since CPT assigned 95992 — our office has not gotten paid for one,” Ruffing says.

95992’s in a Bad State

Why aren’t you getting paid for the...

Tags: 386.11, 92700, 95992, audiology, CPT, ENT, Epley, otolaryngology, status B