Basics of Drug-induced sleep endoscopy (DISE)  CPT code 42975

Drug-induced sleep endoscopy (DISE), also known as sleep nasoendoscopy or nasopharyngoscopy, is an upper airway evaluation technique which uses a flexible fiberoptic endoscope to examine the site of airway obstruction while individuals are in a sedative-induced sleep designed to mimic the natural sleep state. The purpose of DISE is to determine what causes site of airway obstruction during sleep and help surgeons determine and plan appropriate surgical procedures for their patients with OSA who have failed, or were unable to tolerate, positive airway pressure (e.g., CPAP or BIPAP). CPT code 42975 is added in 2022 for reporting DISE procedures.

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Description of CPT code 42975

42975 Drug-induced sleep endoscopy, with dynamic evaluation of velum, pharynx, tongue base, and larynx for evaluation of sleep-disordered breathing, flexible, diagnostic

The physician performs a diagnostic drug-induced sleep endoscopy (DISE) to evaluate the airway of a patient with obstructive sleep apnea (OSA). Also known as sleep nasoendoscopy (SNE), this procedure is typically performed in conjunction with an anesthesiologist. The patient is administered a sedative infusion, often propofol. The dose is carefully titrated in order to cause obstructive apnea but avoiding central apnea. The physician passes a fiberoptic nasopharyngoscope into the nasal cavity and performs a full examination to rule out any airway obstructions. The scope is advanced into the nasopharynx. The physician pauses at this point until the patient begins snoring, at which point the examination continues of the nasopharynx, velopharynx, and hypopharynx. The physician notes the degree of collapse using a standardized grading scale. Obstruction at the level of the palate (palate, tonsils, and lateral pharyngeal wall) and at the level of the hypopharynx (base of tongue, epiglottis, and lateral pharyngeal wall) is noted. The physician may advance the mandible 5 to 10 mm forward so that the action of a mandibular advancement device or a genioglossal advancement is reproduced. Insertion of a nasal trumpet or oral airway, or performance of a jaw thrust maneuver may also be a component of the evaluation.