Coding Challenges with Canalith Repositioning Maneuver CPT 95992
The Vestibular Rehabilitation Special Interest Group would like to invite clinicians to share their billing and reimbursement challenges with CPT code, 95992. Our team members will assist in problem-solving to optimize reimbursement and ensure that the code is being used appropriately. We will showcase different issues and solutions related to usage of the code in our Newsletter and on our website.
Therapists are encouraged to describe their experiences with CPT CODE 95992 by contacting Lisa at mld661@sbcglobal.net
When Canalith Re-positioning (CPT Code 95992) is denied by a payer for reimbursement, a number of factors must be considered to determine the reason. The practice setting and state in which the service is delivered affects reimbursement. Fee schedules also vary among states; for example, an outpatient clinic in Texas that provides both audiology and physical therapy, tracked the usage and reimbursement of the code in 2014. The code was billed 600 times with an average reimbursement of $33.33. In an outpatient multidisciplinary vestibular clinic in Connecticut, the code was billed 759 times in 2014, for an average reimbursement of $48.36.
Reportedly, Medicare in Georgia does not pay for Canalith Re-positioning; whereas, Medicare in Connecticut does, at a rate of $36.78. In Connecticut, as in 9 other states, Medicare is administered by the National Government Services (processes approximately 20 percent of the nation's Medicare Claims) and proper billing is mandatory for timely reimbursement of CPT 95992. It must be linked with a diagnosis of BPPV and if additional procedural codes are used in the same treatment, a modifier may need to be added to the additional code.
Reference: http://www.ngsservices.com/claims.html
UPDATED: Information on the CMS Rule for the Canalith Repositioning Maneuver CPT Code
Background:
CPT 95992 – Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per day
Canalith repositioning is used for the treatment of benign paroxysmal positional vertigo (BPPV). It is covered when performed by physicians, qualified non-physician providers and therapists. The procedure is covered as a single service per day, regardless of the duration required to provide the service or the number of repeat services. It is anticipated that the frequency and the total number of this service provided would be limited to five or fewer encounters, as the patient may be able to be trained to perform these maneuvers on his/her own without the assistance/supervision of a trained professional. The medical record should include documentation of the plan of care, the patient’s progress, and conditions requiring continued supervision by a trained professional.
Coverage for 95992 is limited to the following condition:
386.11 BENIGN PAROXYSMAL POSITIONAL VERTIGO
CPT code 95992 describing canalith repositioning procedure(s) is reported with no more than one (1) unit of service per day and includes all services necessary to achieve the canalith repositioning. Other CPT codes (e.g., 97110, 97112, 97140, 97530) should not be reported separately for services related to the canalith repositioning.”
Canalith Repositioning:
Documentation should include:
- Results of physiologic testing (if performed)
- A plan for the continuing care,
- The progress demonstrated,
- The number of anticipated additional services,
- Explanation of why the patient would be unable to perform the exercises at home without the immediate supervision of a trained professional. Canalith repositioning (95992) should generally be limited to five or fewer encounters. Sessions in excess of this parameter must be documented as to their need and why these exercises cannot be performed by the beneficiary without the supervision of trained professionals.
- When billing for 95992 make sure to list BPPV (386.11) as the diagnosis code
- When billing another treatment CPT code in addition to the CRM code (95992) make sure to document clearly the treatment you provided to support the additional code (exp: neuro re-ed or therex).You should be documenting what type of activities you are performing that are not related to canalith repositioning and how they are separate from the canalith repositioning.The documentationshould explicitly state why this 2nd CPT code was billed.
- At this time there is a CCI edit which requires the use of a modifier when codes are billed in addition to the CRM code.The CCI edits change quarterly so please verify that there is a CCI edit in place for the CRM code at the time of use.CCI edits can be found at the following website: http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html.At the bottom of the page you will see a box that is labeled “Related Links”.Click on “Physician CCI edits”
- The 59 modifier should be applied to the other CPT code(s) billed in conjunction with the CRM code (95992).
- Also when billing another code such as neuro re-ed with the CRM code, make sure that you add a 2nd diagnosis code such as dizziness, imbalance, post-concussion syndrome, vestibular neuritis, etc.
REFERENCES:
- "National Correct Coding Initiative Policy Manual for Medicare Services" in Chapter 11, page 14.http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html
- LocalCoverage Determination for Outpatient Physical and Occupational Therapy for Medicare Administrative Contractors.Jurisdiction: Wisconsin, Illinois and Minnesota.Pages 55 and 74 of 117
It is important to know that now that there is a code for CRM, you may not use another code instead, even if you are having trouble with denials, or if another code's reimbursement is better. The code must be used by law for any CRM procedure. The code is for the assessment (Dix-Hallpike), treatment (CRM) and post-treatment instructions for each visit. If, during the visit, you also perform other exercises or procedures, you may bill for them as well. If you bill for other procedures, make sure that you use the proper modifiers (-59) to cover for multiple procedures in a session. It is an untimed code and can only be billed once per day.
The Medicare Fee Schedule payment rate for your location can be calculated using the APTA Medicare Fee Schedule Calculator. You must be a member to use this feature.
The APTA has recently published a list of FAQ's regarding standard coding guidance and practice. Thank you Sue Whitney and the Practice committee, along with the APTA leadership for your work in putting this very useful document together!
Medicare G code Information
Thank you to Kenda Fuller, PT for providing the Vestibular Rehabilitation SIG with an excellent overview of the G code process, focused on the issues that are important for vestibular rehabilitation. Below are links for Kenda's video presentations on G Codes, as well as an outline of the powerpoint presentation.
Entire G Code Presentation
G Code Overview
Severity Measures
Case Example
Outline of powerpoint presentation
Case Study by Richelle Dack, PT
Please note that this information is provided to the best of our knowledge and ability, and is not the expressed position or opinion of the APTA.
General Neurology G Code information can also be found HERE.