Get Paid for Genioglossus Advancement

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In CPT
October 5, 2009
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Having trouble getting paid for genioglossos advancement? The American Academy of Otolaryngology — Head and Neck Surgery and your state otolaryngology society may be of assistance.

The AAO-HNS recently sent letters to Wisconsin Physician Services (WPS) and Anthem Blue Cross regarding their coverage policies for mandibular segmental osteotomy with genioglossus advancement (21199, Osteotomy, mandible, segmental; with genioglossus advancement) when performed to treat obstructive sleep apnea (OSA).

“We wrote a letter (to WPS) indicating that it should be covered, and, as a result of the information we provided, they decided to cover it on a case-by-case basis,” says Udo Kaja, AAO-HNS’s health policy program manager.

After confirming whether your payer will reimburse 21199, check your diagnosis code selection, advises Otolaryngology Coding Alert. CPT® code “21199 treats OSA (327.23 Organic sleep apnea; obstructive sleep apnea [adult] [pediatric]) and not any of several other sleep disorders, such as central sleep apnea (327.21, Primary central sleep apnea), where the brain forgets to breathe but there are no physical obstructions,” writes the medical coding newsletter.

Tip: Make sure 327.23 has been confirmed with a sleep study.

Read more about OSA and new policy requirements for sleep studies on the Coding News Web site.

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