Check CPT® 2016 for Vestibular Test Coding Changes

Posted on 29 Oct, 2015 |comments_icon 6|By Chris Boucher

Also, a pair of sinus implant procedures get category III codes.

Otolaryngology practices won’t want to sniff and turn up their noses at the changes that CPT® 2016 will bring.

Why? There are several changes that will affect your coding starting January 1. The bright side, however, is that these changes seem to favor the provider when it is procuring payment.

Take a look at the major changes that will affect otolaryngology coding in 2016.

Expand Caloric Vestibular Test Options

Physicians conduct a caloric vestibular test to evaluate whether there is something wrong with the vestibular (balance) portion of the patient’s inner ear. The test also evaluates areas of the brain that are involved with balance and can help isolate dizziness symptoms to a specific cause that might be treatable.

In the past, you’ve had a single procedure code to report for caloric vestibular tests. CPT® 2016 will delete that familiar code — 92543 (Caloric vestibular test, each irrigation [binaural, bithermal stimulation constitutes 4 tests], with recording) — in favor of two new codes:

  • 92537 — Caloric vestibular test with recording, bilateral; bithermal (i.e., one warm and one cool irrigation in each ear for a total of four irrigations)
  • 92538 — … monothermal (i.e., one irrigation in each ear for a total of two irrigations).

“With the current coding, practices have had a difficult time getting paid for the four units they bill for 92543 based on CPT® code instructions,” says Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CENTC, CPCO, vice president of the coding and consulting division of J. & S. Stark Billing & Consulting, Inc., in Shrewsbury, N.J. “They often get paid for one unit. It appears that payment will be more accurate and less difficult to obtain with these two new codes since we won’t be fighting for units. We’ll either bill one unit of 92537 if the physician performs four irrigations, or one unit of 92538 if he completes two irrigations.”

Use ‘T’ Code on Drug-Eluting Sinus Implants

You’ll also find two new codes for placing a sinus implant, as follows:
0406T — Nasal endoscopy, surgical, ethmoid sinus, placement of drug eluting implant
0407T — … with biopsy, polypectomy or debridement.

Key differences: You would use these codes when your provider places PROPEL drug-eluting sinus implants during a separate encounter, not at the time of endoscopic sinus surgery. Codes 0406T and 0407T do not apply to the use of other stents, spacers, or packing materials. You should only consider reporting them for products approved by the FDA as “drug-eluting sinus implant” (PROPEL is the only one at this time).

When the provider performs the service described by 0407T, he removes tissue from the ethmoid sinus via biopsy, polypectomy, or debridement. The existing CPT® codes that represent sinus tissue removal (31267, 31276, and 31288) are for the maxillary, frontal, and sphenoid sinuses. Now you’ll have a more accurate code to report when the ENT does a similar procedure in the ethmoid sinuses.

Consider CodingCon for More ENT Info

If you’re interested in learning more about ENT-specific coding, you might want to attend The Coding Institute’s CodingCon 2015 in December. For more information about the conference’s otolaryngology track, go to:

To register for The Coding Institute’s CodingCon 2015, go to: or call 866-251-3060.


Chris Boucher

Chris Boucher has nearly 10 years of experience writing various newsletters and other products for The Coding Institute. His blog will cover several areas of coding and compliance, including CPT® coding, modifiers, HIPAA compliance and ICD-10 coding.

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