(Otolith Repositioning; Epley Maneuver; Semont Maneuver, Lateral canal repositioning maneuvers)
|Procedure||CPT||RBRVS Global Days|
|Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per day||95992||XXX|
1. History (one or more required)
- Description of paroxysmal vertigo or unsteadiness
- Vertigo, typically lasting less than a minute, usually associated with lying down, sitting up, turning side to side in bed, or any significant movement of the head and neck.
- Functional impairment due to vertigo
- History of head trauma (especially in younger aged individuals where idiopathic Benign Paroxysmal Positional Vertigo (BPPV) is less common)
- History of Meniere’s disease
- History of vestibular neuritis
- No evidence of neck or back disorders that might contraindicate
a) Neurotologic examination:
- Otoscopy and complete otolaryngologic exam
- Spontaneous or gaze nystagmus
- Cranial nerve testing
- Dix-Hallpike maneuver
- With or without Frenzel lenses or video goggles
- Sidelying maneuver (lateral canal BPPV)
b) Positional Testing (with or without Frenzel lenses or video goggles) if Dix-Hallpike maneuver negative
3. Tests (optional)
- Electro- or videonystagmography (ENG/VNG)
- Vestibular Evoked Myogenic Potentials (VEMP)
- MRI or other site of lesion testing (eg, Otoacoustic emissions, Auditory Brainstem Audiometry), if persistent symptoms
- If sudden hearing loss is associated2
- Various Canalith Repositioning Procedures (i.e., Epley, Semont, Lateral Canal, etc.) depending on examination findings.
- Vestibular exercises (for milder symptoms with no findings on examination) or Vestibular Rehabilitation in select patients.
- One-two weeks
a) Presence or absence of positional vertigo
- Beyond One Month
a) Recurrence or persistence of positional vertigo
b) Resumption of normal life style
c) Consideration for further evaluation if symptoms persist or other neurological findings.
Associated ICD-10 Diagnostic Codes (Representative, but not all-inclusive, codes)
R42 Dizziness and giddiness
H81.10 Benign paroxysmal vertigo, unspecified ear
H81.11 Benign paroxysmal vertigo, right ear
H81.12 Benign paroxysmal vertigo, left ear
H81.13 Benign paroxysmal vertigo, bilateral
Benign paroxysmal positional vertigo is one of the most common causes of vertigo. This inner ear problem is caused by calcium carbonate crystals (“otoliths”) floating in the fluid of the inner ear. On position change, these crystals stimulate part of the inner ear and produce short periods of dizziness. Causes for the crystals to break away are head injuries, degenerative diseases, viral infections of the inner ear or auditory-vestibular nerve (vestibular neuritis), or are unknown. In time, these crystals may settle and symptoms resolve. It is common for symptoms to recur if the condition has never been treated.
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Clinical indicators for otolaryngology serve as a checklist for practitioners and a quality care review tool for clinical departments. The American Academy of Otolaryngology—Head and Neck Surgery, Inc. and Foundation (AAO-HNS/F) Clinical Indicators are intended as suggestions, not rules, and should be modified by users when deemed medically necessary. In no sense do they represent a standard of care. The applicability of an indicator for a procedure must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical indicators will not ensure successful treatment in every situation. The AAO-HNS/F emphasizes that these clinical indicators should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. The AAO-HNS/F is not responsible for treatment decisions or care provided by individual physicians. Clinical indicators are not intended to and should not be treated as legal, medical, or business advice.
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2 see AAO-HNS Clinical Practice Guideline on Sudden Hearing Loss