Question
What codes should we use for CRP, canalith repositioning procedure/Epley Maneuver?
Answer
The answer to this question is: it depends on who's paying. And for that, you'll need to check the website of the insurer, to see if they have any type of decision coverage on that.
Your Medicare carrier at your state level, usually that's a subsidiary of the Blues, typically has some documentation or a carrier decision on how to code for this. But the various options I have come across include 92700, which is the unspecified otolaryngologic procedure; 97110, therapeutic exercises; 97112, neuromuscular re-education; or 97530, therapeutic exercises. Which one you bill, again, depends upon the payer.
Now, one thing that you can do... Every insurance company has an office of provider education. And every insurance company, and HMO, has a provider liaison. What you can do is to call them.
You don't want to ask, "What code do you use for CRP or for Epley?" because they won't tell you. What you do ask is, "Can I report 97110 with this diagnosis?" and you fill in the blank for what diagnosis you want to use. And they will typically come back and say, "Yes, you can, " or "No, you can't." And so you give them the code and you find out if they will authorize payment for it.
But these are the four most common codes I've come across for Epley, and this simply highlights that we need that new code for the CRP, aka Epley.
What's the code for the Dix-Hallpike?
That is 92542, a positional nystagmus test, minimum of four positions, with recording. The reason why 92542 doesn't say "Dix-Hallpike" is because, when this code came into existence, the AMA had a rule, at that time, that said you could not use a proper name as part of the code descriptor. The descriptor had to describe the procedure itself, in which case you are putting the patient into various positions, looking for the onset of nystagmus.
How many times can 92547 be billed?
Up to seven times per date of service, IF--and you'll notice I have "if" in capital letters--number one, you used good old fashioned surface electrodes, two of them, above and below the eye, for a vertical channel. And you can bill it once per unit of service for 92541, 92542, one time for each of those. 92543 is billable up to four units, so that's four times. 92544, and also 92545, each of those is billable in one unit per date of service. However, you must know that there is a CCI edit to prohibits the reporting of 92541 with the other balance codes on the same date of service. You won't find this under "92541" on the CCI edit list, but you will see it when you look at the other balance codes.
So up to seven times is what you are allowed for 92547, but only if you use electrodes. If you use goggles to record nystagmus, you must not bill 92547, under any circumstance. That's the one compromise we came to with the AMA when they wanted to cut us off from that code completely.
So if you use goggles, don't bill 92547. If you use electrodes, that's fine. You can piggyback it onto each of the other codes that you use.
Robert Fifer, Ph.D., is the Director of Audiology and Speech-Language Pathology for the Mailman Center for Child Development at the University of Miami School of Medicine. He is also an Audiology Online Contributing Editor in the area of Coding and Billing. He is the ASHA representative to the American Medical Association's Health Care Professions Advisory Committee for the Relative Value Utilization Committee in addition to being ASHA's representative to the AMA's Practice Expense Advisory Committee.
Editor's Note - The above is a partial transcript from the Coding and Billing QNA Live e-Seminar that was conducted on Audiology Online on June 27, 2007. (The recorded version is available here - Also the complete edited transcript is available here. The format of the session was different from most traditional presentations as we solicited questions ahead of time and also solicited questions during the event and had Dr. Fifer focus on answering those questions during the live session. We have published the transcript from the seminar in a semi-rough format to preserve the live feel from the session and to accelerate the publication timeline of this information to the Audiology Online readers. Submitted questions are bolded, followed by Dr. Fifer's response. Dr. Fifer is a frequent Contributing Editor for Audiology Online in this area, look for additional Coding and Billing QNA sessions on our home page in the near future. - Paul Dybala, Ph.D. - Editor
