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rerouting of palatal muscles with or without pterygoid

Debbie Posted Wed 27th of November, 2013 09:45:00 AM

Our ENT Surgeon wants to do a new procedure for the treatment of Patulous Eustation Tube Dysfunction. It is like a Eustation Tuboplasty, however, he is going through the Palate. We believe it is called Rerouting of the Palatal Muscle with or without Pterygoid Hamulotomy. What CPT code would we use for that?

SuperCoder Answered Wed 27th of November, 2013 19:16:06 PM

Otolaryngologists may use several studies, such as Valsalva, Frenzel and Politzer, to test the patency or openness of the eustachian tube. Unfortunately, CPT does not provide a code that matches any of these patency or function tests. Some otolaryngologists assign 92567 (Tympanometry [impedance testing]). But 92567 allows payment for the pressure reading only and not the additional tests.

To encourage CPT to identify the studies in the future, you should report unlisted-procedure code 92700 (Unlisted otorhinolaryngological service or procedure), submit the claim on paper and attach an explanation of the study performed. This way, you are coding to the highest specificity and allowing the AMA to collect data on unlisted procedures. The only way to get a new code is through the AMA. You should notify the American Association of Otolaryngologists that there is need for codes to define these procedures, so AAO can lobby for their creation.

In Valsalva, the otolaryngologist takes a pressure reading using a tympanometer. The physician then has the patient try to exhale while pinching his nose and keeping his mouth closed. Asubsequent tympanogram shows whether the tube is open or closed.

The Frenzel maneuver is the opposite of the Valsalva inflation. The patient takes a mouthful of air and, while keeping his mandible open, he closes his lips and pinches his nose. The air in the oral cavity is then compressed by raising the tongue and pressing the cheeks.

In the Politzer test, the physician forces air up the eustachian tube by having the patient close off his soft palate by either saying "k-k-k" or swallowing water, then blowing air into one nostril while the other one is pinched.

Debbie Posted Mon 02nd of December, 2013 17:26:31 PM

Our physician is NOT testing for the patency; he is performing a surgery/procedure to treat it by sticking something up through the palate and crushing the bones to make the tube collapse. So would we still use cpt 92700 or should we use 42299 for an Unlisted procedure of the Palate?

SuperCoder Answered Wed 04th of December, 2013 01:41:29 AM

You can choose 92700 as it can be used for 'without patency' also.

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