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Otolaryngology Coding Alert

Reader Questions:

Use 2 Codes When ENT Occludes Canal

Question: What CPT code should I use for "posterior semicircular canal ablation," which the otolaryngologist identifies as a "standard procedure"? New York Subscriber Answer: Otolaryngologists usually refer to this procedure as posterior semicircular canal occlusion, rather than ablation. The surgeon typically first performs a complete mastoidectomy to find the posterior semicircular canal. He then performs further drilling until he identifies the posterior semicircular canal membrane. Finally, the otolaryngologist occludes the canal by packing it tightly with bone wax, bone or whatever is available for this purpose. No specific code exists for this procedure, which an otologist would more likely perform than a general otolaryngologist. The surgeon performs posterior semicircular canal occlusion as a last resort for intractable benign paroxysmal positional vertigo (BPPV, 386.11). Do this: Code the mastoidectomy complete (69502, Mastoidectomy; complete) and use the unlisted-procedure inner ear code (69949) for the occlusion. In your cover letter for 69949,-compare the occlusion to 69820 (Fenestration semicircular canal), which is perhaps the best example of what posterior semicircular canal occlusion is similar to, or 69805 (Endolymphatic sac operation; without shunt), which is similar to the occlusion in terms of complexity and risks.