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Published: December 1, 2020

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NEW CATEGORY I CPT CODES FOR SLEEP SURGERY IN 2022

At the October 2020 American Medical Association (AMA) Current Procedural
Terminology (CPT) Editorial Panel meeting, the AMA accepted new Category I CPT
codes for both hypoglossal nerve stimulation (HGN) and drug-induced sleep
endoscopy (DISE). These new codes will become part of the CPT code set in 2022.
For CPT, ‘Category’ refers to the division of the code set. CPT codes are
divided into three categories.



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At the October 2020 American Medical Association (AMA) Current Procedural
Terminology (CPT) Editorial Panel meeting, the AMA accepted new Category I CPT
codes for both hypoglossal nerve stimulation (HGN) and drug-induced sleep
endoscopy (DISE). These new codes will become part of the CPT code set in 2022.
For CPT, ‘Category’ refers to the division of the code set. CPT codes are
divided into three categories. Category I is the most common and widely used set
of codes within CPT. It describes most of the procedures performed by healthcare
providers across various sites of service.


HYPOGLOSSAL NERVE STIMULATION

Accepted addition of codes 645X1, 645X2, 645X3 to identify hypoglossal versus
vagal nerve stimulator services; Revision of codes 64568, 64575, 64580, 64581 to
separately identify hypoglossal nerve stimulator service from vagus nerve
stimulator services; and Deletion of Category III codes 0466T, 0467T, 0468T.


DRUG-INDUCED SLEEP ENDOSCOPY

Accepted addition of code 42XXX to report drug induced sleep endoscopy flexible,
diagnostic.

Note: Codes that contain an ‘X’ (e.g., 1002X4, 234X2X, 0301XT) are placeholder
codes that are intended, through the first 3 digits, to give readers an idea of
the proposed placement in the code set of the potential code changes.

Please visit the Academy’s Coding Corner at
https://www.entnet.org/content/coding-corner for additional updates, as well as
the newest coding and reimbursement tools for members.

Due to the public health emergency, the October CPT meeting was held virtually.
Academy advisors and clinical experts participated in the new virtual format to
advance these codes on behalf of the specialty. The creation of Category I codes
is a critical first step to adoption of new procedures and services frequently
performed by otolaryngologist-head and neck surgeons. However, much advocacy
work remains to be done.

Prevalence rates of obstructive sleep apnea have increased substantially over
the last two decades. It is now estimated that at least 25 million adults in the
United States (26% of adults between the ages of 30 and 70 years) have sleep
apnea. Other estimates suggest the total number of adults who suffer from sleep
apnea is much higher with a total number of 54 million cases. Of this patient
population, approximately 13% of men and 6% of women have moderate to severe
obstructive sleep apnea (apnea-hypopnea index or AHI ≥ 15.)


HYPOGLOSSAL NERVE STIMULATION (HGN)

Currently HGN is reported using CPT code 64568 [Incision for implantation of
cranial nerve (e.g., vagus nerve) neurostimulator electrode array and pulse
generator] with both 64569 and 64570 utilized for replacing or removing the
device. The codes were originally created for other stimulators and are also
used to define placement of stimulators on other nerves, most commonly the vagus
nerve. The placement of the electrode array and pulse generator on the vagus
nerve, as compared to the hypoglossal nerve, differs with the latter procedure
being more difficult and requiring more dissection of the nerve to identify
those branches that protrude the tongue.

The only hypoglossal nerve stimulator with current U.S. Food and Drug
Administration (FDA) approval includes a sensor that is implanted into the chest
wall intercostal muscles through a separate incision, with a subcutaneous
attachment to the pulse generator to pace tongue extrusion with inspiration.
Category III CPT code +0466T and supporting codes 0467T and 0468T were
established in 2016 to capture the additional work required to implant the
inspiratory sensor, as well as its replacement or removal. The new codes create
a new code family that is specifically for HGN.

Although the nerve stimulation codes are being separated into their own codes,
the code structure was written so that the two neurostimulator code families
will be similar to the current codes. Additionally, the AMA does not create CPT
codes for specific devices. While there is currently only one FDA-approved HGN
device, new devices are also reportable under the new codes as long as they fit
under the code descriptors. The current device, produced by Inspire Medical
Systems, has been implanted thousands of times since its FDA approval in May
2014. However, the lack of a dedicated CPT code created reimbursement obstacles
at many institutions.



As the new CPT codes cover the procedure in its entirety and are specific to
HGN, the Category III add-on codes (0466T, 0467T, 0468T) used to report these
codes will be deleted from the code set in 2022. It is important to note that
the Centers for Medicare & Medicaid Services has a technical correction in the
calendar year 2021 Medicare Physician Fee Schedule proposed rule changing the
global status of CPT code 0466T to ZZZ. The purpose of this proposed change,
which is supported by the AAO-HNS, is to clarify that the code is an add-on code
that cannot be separately reported for Medicare patients. If included in the
final rule, it would take effect January 1, 2021, and then be rendered obsolete
for 2022 when the new CPT codes become active.


DRUG-INDUCED SLEEP ENDOSCOPY (DISE)

The second new sleep surgery code created by the CPT Editorial Panel for the
2022 code set describes DISE. DISE is currently reported using either CPT codes
31575 (Laryngoscopy, flexible; diagnostic), 31622 (Bronchoscopy, rigid or
flexible), or 92502 (Otolaryngologic exam under general anesthesia). None of
these codes, either alone or in combination, accurately capture the work
involved in examining the dynamic nature and site(s) of airway obstruction
within the nasal cavity, nasopharynx, oropharynx, hypopharynx, and larynx while
under anesthesia in an operative setting, nor are they inclusive of the
examination of the effects of positional and head and neck manipulation on the
obstruction. The AAO-HNS estimates that DISE is performed under 10% of the time
any of these three codes are reported.

DISE has been performed by otolaryngologists for almost 30 years. Utilizing the
new code will assist sleep surgeons in obtaining appropriate reimbursement for
the work performed in the procedure. Since 2014, DISE has become increasingly
more prevalent, as the FDA has deemed it a necessary prerequisite to HGN
implantation. Additionally, the new code eliminates the issues with 31575 by
including sedation, with 31622 by accounting for maneuvers that may alleviate
proximal airway obstruction, and with 92502 as an endoscopic service that
captures the dynamic patency of the upper airway.




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Download PDFArchives


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More from December 2020/January 2021 – Vol. 39, No. 11

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FROM THE EDUCATION COMMITTEES

Obstructive sleep apnea (OSA) is a common condition in children and one that
most otolaryngologists are familiar with. Pediatric OSA has an estimated
prevalence of 1%-4% in the United States.1 In most cases adenotonsillectomy
(T&A) is the first-line therapy. About 500,000 of these procedures are performed
annually in the U.S.

PATIENT SAFETY AND QUALITY IMPROVEMENT

We had just finished the composite resection, and it was late in the evening as
the case had gotten off to a later start. We were done with the case, the drapes
were off, and I had just removed the anode tube to insert the cuffed
tracheostomy tube. I pulled on the upper stay suture to pull the trachea into
view and it immediately came loose—obviously the tracheal ring had been broken
during its placement.

AAO-HNS/F 2020 ANNUAL REPORT

View the AAO-HNS/F 2020 Annual Report

ADVOCACY ISSUE BRIEF: AUDIOLOGY AND SPEECH-LANGUAGE PATHOLOGY INTERSTATE COMPACT

Several years ago the Council of State Governments (CSG) was asked to develop a
model compact for allied health professionals, in this case, audiologists and
speech-language pathologists. CSG is an organization committed to working with
state officials to shape public policy and includes a program dedicated to
developing interstate compacts.


SECTION SPOTLIGHT: YOUNG PHYSICIANS SECTION (YPS)

The YPS kicked off an exciting new year of activities with an engaged and
well-attended General Assembly at the AAO-HNSF 2020 Virtual Annual Meeting & OTO
Experience, hosted by David S. Cohen, MD, our Immediate Past Chair. Dr. Cohen
highlighted some of the YPS accomplishments from the last year, including
extending the Academy’s reduced membership rate for early career
otolaryngologists from one to two years and the introduction of travel grants
for YPS members, which has been provided for the Section for Residents and
Fellows-In-Training in years past.

SPOTLIGHT: HUMANITARIAN EFFORTS – TAMER A. GHANEM, MD, PHD

The Spotlight on Humanitarian Efforts recognizes AAO-HNS members who are
contributing their time and expertise to otolaryngologic patient needs around
the globe. These individuals demonstrate integrity and devotion to humanity
through a self-giving spirit. They are outstanding models to emulate in
fostering a global otolaryngology community.

HUMANITARIAN TRAVEL GRANT: CLEFT CARE IN KIJABE, KENYA

For the past 20 years, teams of otolaryngologists have provided continuous cleft
care for patients in Kijabe, Kenya, through Samaritan’s Purse World Medical
Mission and partnering with IAC-CURE Children’s Hospital and Smile Train.

SECTION SPOTLIGHT: WOMEN IN OTOLARYNGOLOGY (WIO)

Nalini Nadkarni, PhD, a forest ecologist and tree canopy specialist and guest
speaker at the WIO General Assembly, held during the AAO-HNSF 2020 Virtual
Annual Meeting & OTO Experience, described the process of “disturbance and
recovery,” which to me is a good summary of 2020—unexpected disturbances,
feelings of loss and isolation, maybe a crisis of identity. However, these
disturbances, while uncomfortable in the present, can lead to new consequences
and a new state.


YOUR AAO-HNS COMMUNITY OF SUPPORT: YOU WILL NEVER WALK ALONE

This year’s Annual Report provides us the opportunity to ruminate in amazement
one of the most unpredictable and impactful years most of us will encounter.
While experiences varied regionally, nationally, and internationally, we were
all tied together by the disruptive healthcare issues, economic hardships,
underlying social issues, and lack of consensus on how to deal with the pandemic
itself.

PUT YOUR OXYGEN MASK ON BEFORE HELPING OTHERS: THE IMPORTANCE OF WELLNESS

Before taking off in an airplane, we have all heard this all-too-familiar safety
message: a reminder to put your own oxygen mask on before helping others. As
caregivers, we give much of ourselves to ensure the well-being of our patients.
Our profession can bring stress. We bear witness to human suffering. The hours
are long.

OUT OF COMMITTEE: ENDOCRINE SURGERY COMMITTEE

Thyroid nodules are quite common and typically benign. Nonetheless they can be
troubling in many ways to patients who then seek treatment, which often results
in thyroid surgery. Thyroid surgery comes with some generally accepted risks,
and quality of life may become significantly altered in several ways. The
possible need for thyroid hormone supplementation or replacement is one of the
major concerns for these patients undergoing surgery.
© 2022 American Academy of Otolaryngology–Head and Neck Surgery. All rights
reserved.