CODING AND REIMBURSEMENT | Billing and Coding the Vestibular Evaluation

By Alyssa Needleman

This article is a part of the November/December 2017, Volume 29, Number 6, Audiology Today issue.

The vestibular evaluation can include a number of different procedures, and coding for these evaluations can often be confusing. There are several current procedural terminology (CPT^®) codes that should be considered when completing your evaluation.

Basic Vestibular Evaluation

The American Medical Association (AMA) (2016) has identified several CPT codes that are considered “bundled.” A bundled code includes procedures that are most often billed together. Instead of billing all of the individual procedures, just the one bundled code would be reported. The basic vestibular evaluation (92540) is a bundled code, defined as including

• 92541, Spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording,
• 92542, Positional nystagmus test, minimum of four positions, with recording,
• 92544, Optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and
• 92545, Oscillating tracking test, with recording.

These procedural components must be included in their entirety, including a minimum of four positional tests. If all four of these procedural components are not completed on a patient in a single encounter, it is inappropriate to use the bundled 92540 code. Instead, you report the individual codes for the procedures that were performed. However, since the intent of the basic vestibular evaluation is bundled to include four components, when filing the claim for this evaluation a modifier must be added to indicate the procedure was not completed as intended.

In such a situation in which all four of the procedures of the vestibular evaluation were not completed, a modifier 59 would be added to each of the individual codes that were performed to indicate that they were separate and distinct diagnostic procedures to indicate a distinct procedural service. When using the modifier 59, make sure there is appropriate documentation in the report as to why the full basic vestibular evaluation was not performed. Always remember, it is inappropriate to unbundle the vestibular evaluation code for the sole purpose of higher reimbursement by billing the components separately.