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The CPT® Code 42975 refers to a procedure known as drug-induced sleep endoscopy (DISE), which is specifically designed for the evaluation of sleep-disordered breathing, particularly obstructive sleep apnea. This minimally invasive diagnostic procedure allows healthcare professionals to observe the upper airway in real time while the patient is under a controlled state of sedation. During the DISE, a sedative agent, such as propofol or midazolam, is administered by an anesthesiologist to induce a natural sleep state, minimizing any pharmacological interference with the neurophysiology and dynamics of the upper airway. The procedure is performed with the patient lying flat, facilitating optimal visualization of the airway structures. As the patient transitions into sleep and begins to snore, a small, flexible fiberoptic laryngoscope is carefully inserted through one nostril into the throat. This allows the physician to directly observe critical areas including the nose, soft palate, tongue, throat, and voice box. The primary objective of this procedure is to evaluate the pattern of airway collapse and the extent of any obstruction that may be contributing to sleep-disordered breathing. Following the procedure, which typically lasts only a few minutes, the patient is gently awakened, and the recorded images are analyzed to inform potential treatment options. These options may include surgical interventions, the use of oral devices, or continuous positive airway pressure (CPAP) therapy, depending on the findings of the evaluation.
© Copyright 2025 Coding Ahead. All rights reserved.
The drug-induced sleep endoscopy (DISE) procedure, represented by CPT® Code 42975, is indicated for the evaluation of sleep-disordered breathing, particularly in patients suspected of having obstructive sleep apnea. This procedure is particularly useful in cases where traditional diagnostic methods may not provide sufficient information regarding the dynamics of the upper airway during sleep.
The drug-induced sleep endoscopy procedure involves several key steps that are crucial for its successful execution and accurate evaluation of the upper airway.
Following the drug-induced sleep endoscopy, patients are monitored as they recover from sedation. It is important to ensure that the patient is fully awake and stable before discharge. The physician will review the recorded images and findings with the patient, discussing potential treatment options based on the evaluation results. These options may include surgical interventions, the use of oral devices, or continuous positive airway pressure (CPAP) therapy, depending on the severity and nature of the airway obstruction identified during the procedure. Patients may also receive instructions regarding follow-up appointments and any necessary lifestyle modifications to improve their sleep-disordered breathing.
| Short Descr | DISE EVAL SLP DO BRTH FLX DX | Medium Descr | DISE DYN EVAL SLEEP DISORDERED BREATHING FLX DX | Long Descr | Drug-induced sleep endoscopy, with dynamic evaluation of velum, pharynx, tongue base, and larynx for evaluation of sleep-disordered breathing, flexible, diagnostic | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 3 - Special payment adjustment rules for multiple endoscopic procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Endoscopic Base Code | 31575 Laryngoscopy, flexible; diagnostic | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Office-based surgical procedure added to ASC list in CY 2008 or later without MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | GC | This service has been performed in part by a resident under the direction of a teaching physician | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GA | Waiver of liability statement issued as required by payer policy, individual case | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | FS | Split (or shared) evaluation and management visit | GW | Service not related to the hospice patient's terminal condition | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | SG | Ambulatory surgical center (asc) facility service | TV | Special payment rates, holidays/weekends | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2022-01-01 | Added | Code added |
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