Billing and Coding Information
Balance and fall prevention therapies are billable under CPT codes. Doctors can also bill cash for balance and fall prevention treatment and therapies as well. If you have questions, please ask us for additional information.
Are you compliant with Medicare's "Vestibular Function Tests"
L29407 effective 1-1-2010?
Summary of Relevant CPT Codes
Posted 10-13-2010
National Correct Coding Initiative edits lifted on 10/1/10 for single vestibular CPT codes
As previously announced, effective October 1, 2010, CPT codes 92541, 92542, 92544, and 92545 are now allowed to be filed separately, if only one, two or three of these procedures are performed on the same date of service, by the same provider, for the same beneficiary. An NCCI-associated modifier –59, distinct procedural service, is to be appended when filing these codes separately. (Note that no retroactive billing with these NCCI changes for these separate codes is permitted).
If all four codes are performed at the same time, CPT code 92540, the basic vestibular evaluation bundled code, must be utilized for reimbursement by Medicare and the majority of commercial payors. Click here for more information.
Contributed by:
Debbie Abel, Au.D.
Board Certified in Audiology
Director of Reimbursement and Practice Compliance
American Academy of Audiology
1.800.222.2336
www.audiology.org
www.howsyourhearing.org is a NEW consumer web site
Disclaimer: The purpose of the information provided above by the American Academy of Audiology Coding and Reimbursement Committee is to provide general information and educational guidance to audiologists. Action taken with respect to the information provided is an individual choice. The American Academy of Audiology hereby disclaims any responsibility for the consequences of any action(s) taken by any individual(s) as a result of using the information provided, and reader agrees not to take action against, or seek to hold, or hold liable, the American Academy of Audiology for the reader's use of the information provided. As used herein, the "American Academy of Audiology" shall be defined to include its directors, officers, employees, volunteers, members and agents. www.audiologyNOW.org
RECENT NEWS:
Medicare Payment Restrictions Lifted
Effective October 1, 2010
Please review information from the American Academy of Audiology by downloading their PDF entitled, "National Correct Coding Initiative (NCCI) Payment Restrictions Lifted on Single Vestibular Codes-Effective October 1, 2010." Payment restrictions are to be lifted on the single vestibular codes (92540-92541-92542* - 92544-92545).
Thanks are extended to the American Academy of Audiology, the American Speech-Language-Hearing Association, the American Academy of Otolaryngology-Head and Neck Surgery and the American Academy of Neurology for their combined efforts to accomplish this.
NOTE: We will be sending more information pertaining to the referenced “modifier” needed as soon as it becomes available. To be added to our distribution list, please contact us.
VNG, VRT and ICD-9 CODES
For your convenience, we have listed the CPT code for VNG or VRT, description and number of units below, plus common ICD-9 Codes for VNG Testing. Please refer to the AMA's link shown (below) to find specific information for your state/area and current reimbursement rates. Please refer to our disclaimer statement.
https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp
VNG Codes (Videonystagmography)
92540 1 Unit (Effective January 1, 2010)
Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording. NOTE: This new code includes four component codes: 92541 (spontaneous nystagmus), 92542 (positional nystagmus), 92544 (optokinetic nystagmus), and 92545 (oscillating tracking). Do not report 92540 with any of the component codes.
92541 Refer to 92540 (1 unit with modifier after 10-1-10)
Spontaneous nystagmus test including gaze and fixation nystagmus, with recording. These nystagmus tests document and measure the inability of the eyes to maintain a static position as a result of peripheral, CNS (Central Nervous System) or congenital abnormality. The tests are conducted with the eyes open and closed and in “eyes forward” as well as “eyes right” and “eyes left” positions.
92542 Refer to 92540 (1 unit with modifier after 10-1-10)
Positional nystagmus test, minimum of four positions, with recording. These spontaneous nystagmus tests document and measure the inability of the eyes to maintain a static position when the head is in different positions. These tests are valuable in documenting and quantifying patient complaints of dizziness in certain situations or positions. They are sometimes helpful in localizing the abnormality as CNS or peripheral.
92543 4 Units
Caloric vestibular test, each irrigation (binaural bithermal stimulation constitutes four tests), with recording. The caloric tests evaluate the viability of the peripheral end organs by stimulating them with warm and cold water or air while the patient is in the dark. The resulting dizziness and nystagmus is taken as an index of the viability of the organ. This helps in evaluating the ability of the CNS to visually suppress inappropriate dizziness and nystagmus.
92544 Refer to 92540 (1 unit with modifier after 10-1-10)
Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording. The optokinetic test documents and measures eye movements as the patients watches a series of targets moving simultaneously to the right and then to the left. The optokinetic mechanism is at work when the visual movement in one direction encompasses more than a single point.
92545 Refer to 92540 (2 units with modifier after 10-1-10)
Oscillating tracking test, with recording. The smooth pursuit test evaluates the ability of the patient to keep a moving visual target registered on the fovea. The patient watches a moving target as it moves back and forth in a smooth pendular fashion. The saccadic test evaluates the ability of the patient to find a moving target and tests certain CNS neural integrators. The computer computes the gain (target velocity divided by eye velocity) and compares the gain to age matched norms.
92546 2 Units
Sinusoidal vertical axis rotational testing. This is a computerized test of the Vestibulo-Ocular Reflex (VOR), the neural mechanism that keeps a visual image registered on the fovea during head movement. It evaluates the three functional components of the VOR system: the peripheral end organ, the vestibular nuclei of the brain stem and the higher central vestibular connections. The test is accomplished by having the patient (with goggles on) move their head in both the horizontal and vertical plane at increasing velocities while the VOR system measures head velocity. From this data, the computer computes three characteristics of the VOR: gain (ratio of eye velocity to head velocity, phase (the number of degrees by which the eye “misses” the target), and asymmetry (a comparison of gain moving right with gain moving left). This information is useful for evaluating patients with balance disorders. Refer to this article titled, “VAT Explanation & Justification.”
92547 1 Unit Vertical Recording
VRT Codes (Vestibular Rehabilitation Training)
95992 1 Unit per day
Canalith repositioning procedure(s) (e.g. Epley maneuver, Semant maneuver)
97110 Each 15-minute session
Therapeutic procedure 1 or more areas, each 15 minutes, therapeutic exercise to develop strength, range of motion.
97112 Each 15-minute session
Neuromuscular reeducation of movement, each 15 minutes.
97750 Each 15-minute session
Physical performance test or measurement (e.g. musculoskeletal, functional capacity) with written report, each 15 minutes.
Common ICD-9 Codes for VNG Testing
Codes/Description
386.1 Peripheral vertigo, unspecified
386.11 Benign paroxysmal positional vertigo
386.12 Vestibular neuronitis
386.19 Other peripheral vertigo
386.2 Vertigo of central origin
386.3 Labyrinthitis, unspecified
386.31 Serous labyrinthitis
386.32 Circumscribed labyrinthitis
386.33 Suppurative labyrinthitis
386.34 Toxic labyrinthitis
386.35 Viral labyrinthitis
386.4 Labyrinthitis fistula, unspecified
386.41 Round window fistula
386.42 Oval window fistula
386.43 Semicircular canal fistula
386.48 Labyrinthine fistula of combined sites
386.5 Labyrinthine dysfunction, unspecified
386.51 Hyperactive labyrinth, unilateral
386.52 Hyperactive labyrinth, bilateral
386.53 Hypoactive labyrinth, unilateral
386.54 Hypoactive labyrinth, bilateral
386.55 Loss of labyrinthine reactivity, unilateral
386.56 Loss of labyrinthine reactivity, bilateral
386.58 Other forms and combinations
386.8 Other disorders of labyrinth
386.9 Unspecified vertiginous syndromes and labyrinthine disorders
DISCLAIMER: THE CONTENTS AND MATERIAL CONTAINED IN THIS BILLING AND CODING SECTION ARE SUBJECT TO CHANGE BY A VARIETY OF GOVERNMENT AGENCIES, INCLUSIVE OF MEDICARE. IT IS YOUR RESPONSIBILITY TO CONTACT ANY OF THE NECESSARY GOVERNMENT AGENCIES, EITHER LOCAL STATE AND/OR FEDERAL TO VERIFY GUIDELINES, COMPLIANCE REQUIREMENTS, FEE SCHEDULES, BILLING REQUIREMENTS AND REIMBURSEMENT AMOUNTS THAT MAY AFFECT YOUR SPECIFIC BUSINESS AND GEOGRAPHICAL AREA. THESE MATERIALS ARE PROVIDED AS A REFERENCE AND FOR INFORMATIONAL PURPOSES ONLY | 
