CPT for ENT: Gentamicin Injections

The administration of gentamicin injections is a common procedure performed by otolaryngologists for severe cases of vertigo when observed in some patients with Meniere’s disease. The gentamicin deadens the hair-like fibers that transmit balance information to the brain. Initially, the injections may cause extreme dizziness and/or disequilibrium for several days or weeks.  Depending on a patient’s ability to compensate centrally for the change in vestibular function, the dizziness and/or disequilibrium may dissipate.

Each and every time gentamicin is instilled, report CPT code 69801, Labyrinthotomy, with perfusion of vestibuloactive drug(s); transcanal (Do not report 69801 more than once per day) (Do not report 69801 in conjunction with 69420, 69421, 69433, 69436 when performed on the same ear)

69801 now has a zero-day global period and the tube placement is included in the code. In 2011, changes were made to the code in the CPT manual and documented in the 2011 CPT Changes publication.

The changes include:

• The removal of the reference to cryosurgery including other nonexcisional destructive procedures as these services have become clinically irrelevant and obsolete. Cryosurgery is no longer utilized, and the only type of nonexcisional destruction performed currently is the perfusion of vestibuloactive drugs.
• The revised code also reflects (with the addition of a parenthesis to the “s”in the term drug(s)) that one or more drugs can be injected into the patient’s ears.  (Drugs include anti-inflammatory steroids (e.g., depomedrol, solumedrol, Decadron) and aminoglycosides (e.g., gentamicin, streptomycin, etc.)).
• The removal of the reference to single and multiple perfusions because the frequency, number of injections, and agent differed considerably based on the protocol and clinical presentation
• The deletion of the instructional parenthetical note following 69801 referencing initial and subsequent days of treatment
• The addition of two instructional parenthetical notes directing users not to report code 69801 more than once per day and precluding the reporting of this code with 69420, 69421, 69433, 69436 when performed on the same ear.

The medication itself may be billed for as a separate HCPCS code.  As always, ensure your documentation fully supports your treatment rationale and coincides with the CPT codes submitted in the claim. Be prepared to send clinical notes if the claims examiner needs further information to process the claim.

Revised October 2023

IMPORTANT DISCLAIMER NOTICE

CPT FOR ENT ARTICLES ARE A COLLABORATIVE EFFORT BETWEEN THE ACADEMY’S TEAM OF CPT ADVISORS, MEMBERS OF THE PHYSICIAN PAYMENT POLICY (3P) WORKGROUP, AND HEALTH POLICY STAFF. ARTICLES ARE DEVELOPED TO ADDRESS COMMON CODING QUESTIONS RECEIVED BY THE HEALTH POLICY TEAM, AS WELL AS TO CLARIFY CODING CHANGES AND CORRECT CODING PRINCIPLES FOR FREQUENTLY REPORTED ENT PROCEDURES. THESE ARTICLES ARE NOT INTENDED AS LEGAL, MEDICAL, OR BUSINESS ADVICE AND ARE NOT A GUARANTEE OF REIMBURSEMENT. THE INFORMATION IS ALSO NOT MEANT TO SERVE AS THE DEFINITIVE OR SOLE AUTHORITY ON BILLING AND CODING ISSUES. THE APPLICABILITY OF AAO-HNS BILLING AND CODING GUIDANCE FOR A PARTICULAR PROCEDURE, MUST BE DETERMINED BY THE RESPONSIBLE PHYSICIAN IN LIGHT OF ALL THE CIRCUMSTANCES PRESENTED BY THE INDIVIDUAL PATIENT. YOU SHOULD CONSULT WITH YOUR OWN ADVISORS AS WELL AS MEDICARE OR PRIVATE CARRIERS IN MAKING ANY DECISIONS ABOUT HOW TO BILL AND CODE PARTICULAR SERVICES OR PROCEDURES.