| Clinical Indicators
Canalith Repositioning
(Otolith Repositioning; Epley Maneuver; Semont
Maneuver)
| Approach Procedure |
CPT |
FUD |
| Therapeutic procedure, one or more areas, each 15
minutes; neuromuscular reeducation of balance, coordination, or kinesthetic
sense |
97112 |
XXX |
| Manual therapy techniques; One or more regions;
each 15 minutes |
97140 |
XXX |
| Therapeutic activities, direct patient contact by
the provider (one on one) dynamic activities to improve functional performance
each 15 minutes |
97530 |
XXX |
Indications
1. History
| a) |
Description of vertigo |
| b) |
Functional impairment due to vertigo |
| c) |
History of head trauma |
| d) |
History of upper respiratory infection |
| e) |
No evidence of neck or back disorders that might contraindicate
this manuever |
2. Physical Examination
| a) |
Neurotologic examination:
- Hallpike maneuver
- Spontaneous or gaze nystagmus
- Cranial nerve testing
|
| b) |
Cerebellar examination |
| c) |
Carotid artery auscultation |
3. Tests (optional)
|
- Audiometry
- Electronystagmography (ENG)
|
Outcome Review
1. First Month
| a) |
Presence or absence of positional vertigo |
2. Beyond One Month
| a) |
Presence or absence of positional vertigo |
| b) |
Resumption of normal life style |
| c) |
Consideration for further evaluation if symptoms persist. |
Additional Information
Assistant Surgeon - None
Supply Charges - L0120 Cervical Collar
Anesthesia Codes - None
Patient Information
Benign positional vertigo is one of the most common causes of dizziness seen by
the otolaryngologist. This inner ear problem is caused by crystals 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, decreased blood to the inner ear,
degenerative diseases, and viral infections of the inner ear or are unknown.
This process usually takes from one to twelve months to occur. In time, these
crystals will settle and the symptoms will go away.
The crystals can be repositioned to shorten the time it takes for
positional vertigo to resolve. This repositioning is called the Epley or Semont
maneuver. This is a simple in-office therapy that takes about 30 minutes. The
patient is placed in several different positions during the maneuver which
usually causes temporary dizziness. Patients may wear a neck collar overnight
to help keep the head and neck in position. Many patients have improvement with
this treatment or repeated treatments.
Important Notice
The Clinical Indicators for Otolaryngology--Head and Neck Surgery
are guidelines only. In no sense do they represent a standard of care. The
applicability of an indicator for a procedure, and/or of the process or outcome
criteria, must be determined by the responsible physician in light of all the
circumstances presented by the individual patient. Adherence to these
guidelines will not ensure successful treatment in every situation. The
American Academy of Otolaryngology-Head and Neck Surgery, Inc. 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.
© 2000 American Academy of Otolaryngology-Head and Neck Surgery. One
Prince Street, Alexandria, VA 22314.
|