Neurology Medical Coding Training: Accurately Report the Canolith Repositioning Procedure


Canalith repositioning procedure has been used periodically both by neurology practices, entertain practices as a treatment for benign paroxysmal positional vertigo. It's one of the most common causes of dizziness in patients. It's also abbreviated as BPPV. This coding and compliance article tells you about the new code for reporting the procedure.

It's characterized by brief episodes of mild to intense dizziness. And it's typically associated with specific changes in the position of your head. So, it more commonly occurs when you move your head in a certain direction. Lie down from an upright position or turn over in bed or sit up in the morning.

What this repositioning procedure does is it actually is a prescribed series of movements of the patient's body and head designed to use that force of gravity to redeposit these calcium crystal debris that are in the semicircular or canal system of the ear which causes the BPPV into more neutral part of the ear canal system where they're not going to cause vertigo.

And in that lower right hand corner, you can see some of the phases of positions. And in the upper left hand corner, that's showing the calcium crystal debris that's located in those semicircular canal system.

Thanks to the recent medical coding updates, we now have a final permanent code for it, 95992. Note, it's also called an Epley maneuver, or Sermont maneuver. Note that it says per day. It is typically unilateral in nature but it's typically only performed unilaterally. It's commonly performed in conjunction with an E/M service. The CPT book does say that if we have a separately reportable E/M service - remember, if it's significant and separately identifiable, we can report as significant E/M service without modifier -25, as per medical coding guidelines.

It is a modifier -51 exempt code. We have a big issue here as that Medicare has determined this to be - there are valid RVUs out there that are established for the code, 95992. However, Medicare has taken the stance - is that they've got a “B” status indicator, meaning it's bundled or not separately payable.

When questioned by attendees at the AMA meeting, the head, Dr. Ken Simon from CMS responded that physicians would continue to report this procedure in their appropriate E/M service. Not only do physicians perform this but often audiologists or physical therapist. He said from a medical stance, this procedure has been performed for several years and billed as a part of an E/M service. And it's going to be continued to be reported - from a Medicare stance, would be continued to be reported under the E/M service.

If it's being performed by a physical therapist, they typically report under a variety of CPT codes. But one of the more common is medical coding option 97112. That's a therapeutic procedure, one or more areas each 15 minutes -- neuromuscular reeducation of movement, balance, et cetera. And that physical therapists usually bill this out for two units. Physical therapists would continue to report the appropriate therapy service.

Our corresponding HCPCS code, the S code that of course was not reportable to Medicare historically in the past has been deleted. So again, we have a new code. It will be usable, reportable to all payers. But for Medicare, they are not going to provide separate reimbursement. But we do have RVUs established so there’s a potential payment option from other payers.

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