- Coding for Computerized Dynamic Posturography (CDP), effective January 1, 2020
- Electronystagmography (ENG) / Videonystagmography (VNG)
- Canalith Repositioning Maneuvers
- Rotational Testing
- Functional Balance and Posturography
- Emerging Vestibular Diagnostic Tests (e.g., vestibular myogenic evoked potential [VEMP] testing and video head impulse test [vHIT])
Coding for Computerized Dynamic Posturography (CDP), effective January 1, 2020
Effective January 1, 2020, Current Procedural Terminology (CPT ® American Medical Association) codes related to the evaluation of functional balance using Computerized Dynamic Posturography (CDP) have been revised. Guidance is forthcoming from the CPT Assistant on the appropriate use of CDP codes. Updates will be provided here after the guidance has been published. Additional questions regarding 2020 changes can be directed to firstname.lastname@example.org.
Electronystagmography (ENG) / Videonystagmography (VNG)
Q: What is included in the coding for the basic vestibular evaluation (92540)?
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 4 positions, with recording
- 92544, Optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording
- 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 in a single encounter on a patient, it is inappropriate to use the bundled 92540 code. Instead, you report the individual codes 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 59 (Distinct Procedural Service) must be added to indicate the procedure was not completed as intended, and that the unbundled codes are being used in lieu of the bundled code. Caloric irrigations are not included as part of the basic vestibular evaluation and should be billed separately.
Q: I was told I needed to use a modifier if all components of the basic vestibular evaluation (92540) were not completed; what does this mean and how do I document that?
When a specific procedure is not completed as intended, a modifier is reported with the CPT code in order to provide a better description or more information about the service provided. In a situation in which all four of the component procedures of the vestibular evaluation were not completed, a “-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. For example, if only positional testing was completed with no other components of the VNG, the provider would file 92542-59, with the “92542” to indicate the positional nystagmus test, and “-59” to indicate a distinct procedural service. When using the -59 modifier, make sure there is appropriate documentation in the report as to why the full basic vestibular evaluation was not performed. It is inappropriate to unbundle the vestibular evaluation code for the sole purpose of higher reimbursement by billing the components separately.
Q: Does the basic vestibular evaluation (92540) include caloric irrigation(s)?
Caloric irrigations are not included as part of the basic vestibular evaluation and should be billed separately. There are two codes for caloric irrigations:
- 92537, Caloric vestibular test with recording, bilateral; bithermal, (i.e., one warm and one cool irrigation in each ear for a total of four irrigations)
- 92538: Caloric vestibular test with recording, bilateral; monothermal, (i.e., one irrigation in each ear for a total of two irrigations)
These CPT codes (92537 and 92538) cannot be reported together on the same date of service. In the event four irrigations were attempted but only three irrigations were actually performed, 92537 (bilateral, bithermal caloric vestibular test) should be reported with the -52 modifier to indicate a reduced procedural service. In the unlikely event six irrigations were completed to include ice water calorics, 92537 should be reported with the -22 modifier to indicate an unusual procedural service, requiring significantly more time than usual
Q: Our ENT practice is considering training a technician to do VNG testing. Is this allowed, and if so, what are the rules for coding the VNG?
Technicians can perform the VNG test battery, but there are considerations. With regard to Medicare reimbursement, depending on the qualifications determined by your Medicare contractor, individuals who are also hearing instrument specialists, students of audiology, or other health care professionals may furnish the labor for appropriate audiology services under direct physician supervision when these services are billed by physicians or hospital outpatient departments. These individuals may only perform the tests of those codes that have a technical component (TC)/professional component (PC) split (92537, 92538, 92540-92546, 92548, 92585, 92587 and 92588). In these cases, physicians may bill the TC for services furnished by technicians when the technician furnishes the service under the direct supervision of that physician. These individuals must also meet the requirements of the Medicare contractor to whom the claim is billed. The physician would also bill the PC in this scenario. Generally, private insurers follow Medicare rules. It is recommended you consult directly with your Medicare contractor and private payers regarding their policies related to technicians performing VNG services.
Q: I was told to use the “use of vertical electrodes” code (92547) with a videonystagmography (VNG) system. Is this a proper use of this code?
No, this is not an appropriate use of this code. 92547 should only be used when scleral coil electrodes (or surface electrodes) are used when performing electronystagmography (ENG) testing. Vertical tracking with VNG goggles does not satisfy the conditions for using 92547.
Q: Can an audiologist bill for a “Dix-Hallpike” and if so, what is the correct procedure code?
Yes, an audiologist can bill for the procedure, although there is no specific CPT code for “Dix-Hallpike”. The Dix-Hallpike maneuver is typically considered a positional component of 92542, positional nystagmus test, minimum of 4 positions. This code would be used whether completed as part of the basic vestibular evaluation (92540), or performed in isolation. If performed in isolation, 92542 should be reported with the -59 modifier to indicate a distinct procedural service.
Canalith Repositioning Maneuvers
Q: What is the proper payment and coding for an Epley/Semont procedure? Is this the same code for any canalith repositioning maneuver (e.g., barbeque roll, Yacovino maneuver, etc.)?
Canalith repositioning is billed using CPT 95992, Canalith repositioning procedure(s), per day. The procedure is covered as a single service per day, regardless of the duration required to provide the service or the number of repeat services. It may include such maneuvers as Epley, Semont, Yacovino, and barbeque roll. The medical record should include documentation of the plan of care, the patient’s progress, and conditions requiring continued supervision by a trained professional. This procedure is not covered by Medicare when completed by an audiologist, as Medicare does not cover treatment services provided by audiologists. It is best to check with your individual third party-payers on if they will reimburse this procedure, as each private health plan develops its own coverage position.
Q: What is the best way to bill for auto head rotation (VAT) testing? Is 92546 the appropriate code?
Rotational chair testing is typically billed with 92546, sinusoidal vertical axis rotational testing. Billing CPT code 92546 only applies to horizontal plane testing and the audiologist should not use this code to bill for additional axes. This code should only be billed if your office has a rotational chair. It is inappropriate to use this code for Active Head Rotation such as VAT or VORTEQ, headshake or spinning in an office-type chair. Some payers may require inclusion of the serial number of the rotary chair in your report documentation, to demonstrate use of the rotational chair unit.
Q: Is there a minimum number of frequencies needed to bill for rotational testing such as the sinusoidal harmonic acceleration (SHA) test and velocity step testing?
A more detailed description of minimum test requirements for 92546, sinusoidal vertical axis rotational testing is not available. There is no guidance regarding minimum number of frequencies or direction of testing.
Q: How do you bill for subjective visual vertical (SVV)? What about unilateral centrifugation (UC)?
Currently, there are no codes available for these procedures. SVV can be assessed using a rotary chair, in which case, the Academy recommends coding 92700, unlisted otorhinolaryngological service or procedure, with its required documentation would be appropriate. Whenever billing an unlisted code such as 92700, it is important to consult your third-party payer guidelines for additional documentation requirements necessary for submission with the claim. Cell phone applications and the “bucket test” are considered screening procedures and are not considered billable services by Medicare and most third-party payers. As a reminder, modifiers are not typically used when using 92700, nor is it customary to bill multiple units of this code. For additional reading, click here.
Functional Balance and Posturography
Q: What type of equipment must be used to qualify for billing “computerized dynamic posturography”, CPT code 92548? Also, is there a minimum battery of tests that must be performed in order to bill this code?
Computerized Dynamic Posturography (CDP), also known as dynamic posturography, balance board testing, equilibrium platform testing (EPT), and moving platform posturography testing is typically billed with 92548, computerized dynamic posturography. This code should only be billed if your office has a room with a true dynamic platform. It is inappropriate to use this code for measuring falls on foam without an accompanying computer for data analysis. Some payers may require inclusion of the serial number of the dynamic platform posturography system in your report documentation, to demonstrate use of the dynamic platform. A more detailed description of CDP in terms of a minimum test requirements is not available. Although CMS may provide payment for this procedure, it is best to check with your third party-payer on if they will reimburse, as many cite this procedure as investigational and not medically necessary.
Q: I do a sensory organization performance test on all of my patients (e.g., CTSIB, Gans SOP, etc.). How do I bill for this?
There is currently no specific CPT code for sensory organization testing. Sensory organization testing conducted on its own or with foam without the use of a dynamic platform would be considered a screening test, and would not be reimbursed by most third-party payers.
Emerging Vestibular Diagnostic Tests (e.g., vestibular myogenic evoked potential [VEMP] testing and video head impulse test [vHIT])
Q: What is the best way to bill for vestibular-evoked myogenic potential (VEMP) testing? What about the video head impulse test (vHIT)?
There are currently no specific CPT codes for VEMP or vHIT testing. Since there is no CPT code available, the Academy recommends coding 92700, unlisted otorhinolaryngological service or procedure. Whenever billing an unlisted code such as 92700, it is important to consult your third-party payer guidelines for additional documentation requirements necessary for submission with the claim. Some practitioners have incorrectly used 92585, auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive when completing a VEMP. However, this code is specific to auditory potentials for evoked response audiometry, while the VEMP is an evoked electromyogenic potential for vestibular assessment. As such, current guidance recommends the use of 92700 for this procedure. As a reminder, modifiers are not typically used when using 92700, nor is it customary to bill multiple units of this code. For additional reading, click here.