H83.19 — Labyrinthine fistula, unspecified ear
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request; every page must be legible and include patient identification and dates of service.
- The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing care to the patient.
- The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
- A valid order from the treating physician or non-physician practitioner is required (per CFR Title 42 §410.32(a)) and the ordering physician must appear on the audiologist claim.
Key Coverage Criteria
- Continuous intraoperative neurophysiologic monitoring provided one-on-one in the operating room (CPT 95940) is covered when it supports the covered indications in LCD L35003.
- Report continuous intraoperative neurophysiologic monitoring in the operating room (95940) in addition to monitoring services provided from outside the operating room (G0453); coverage includes interpretation of baseline studies and removal of electrodes at the end of the procedure when supporting the LCD indications.
- Reimbursement may be made for covered intraoperative monitoring when performed at POS 19, POS 21, POS 22, or POS 24.
- Vestibular function testing is covered when medically necessary to evaluate balance or suspected vestibular dysfunction and when other physiological, psychological, medication-related, or systemic causes of balance problems have been ruled out.
- CPT 92537 (caloric vestibular testing) is intended for a complete caloric test consisting of bilateral bithermal irrigations (one warm and one cool irrigation for each ear).
- CPT 92538 (monothermal irrigation) is used when both ears are irrigated with the same temperature (monothermal) and reported once for that bilateral monothermal procedure.
8 Active Policies
A57434 — Billing and Coding: Vestibular and Audiologic Function Studies
J12
L35003 — Intraoperative Neurophysiological Testing
J12
L35007 — Vestibular and Audiologic Function Studies
J12
A56722 — Billing and Coding: Intraoperative Neurophysiological Testing
J12
L33966
Related Codes
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