CODING AND REIMBURSEMENT | Specialty Series: Vestibular Diagnostic Assessment

By Sydney Nance, M.C. Rincon, Andrea Gohmert, and Anna M. Jilla

This article is a part of the May/June, Volume 35, Number 3, Audiology Today issue. 

As technologies for diagnostic vestibular testing continue to evolve, it is expected that coding and billing for these services will also change. It is important for clinicians to understand how to code and bill for these procedures. We will also discuss newer vestibular assessment methods and appropriate methods of reporting them. The scope of this article will be limited to vestibular diagnostic assessment as many payers do not currently reimburse audiologists for rehabilitative aspects of vestibular care.

Identifying Coverage Policies for Vestibular Testing

Coverage policies for vestibular assessment will vary by payer, and specifically those in Original Medicare (Part B) will be specific to the local coverage determination in that Medicare regional jurisdiction; a tutorial on identifying local coverage determination processes was provided in a previous issue of Audiology Today (Jilla and Kovar, 2023). Further, benefits through Medicaid or Children’s Health Insurance Program (CHIP) plans will vary from state to state. Clinicians should contact insurers and reference relevant coverage policies to determine coding and billing nuances that may be payer specific. The purpose of this article is to discuss generic coding considerations when filing claims for vestibular assessment procedures.

Electronystagmography and Videonystagmography 

The Current Procedural Terminology (CPT) code that best encompasses the work involved in electronystagmography (ENG) or videonystagmography (VNG) is the basic vestibular evaluation code (92540). Basic vestibular evaluation (92540) is a bundled code and includes the following component procedures:

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

*Do not bill in conjunction with 92540.

When billing for 92540 (basic vestibular evaluation), all four components of the bundled code must be completed for appropriate reporting. For procedures included in the bundled basic vestibular evaluation code (92540), it should also be noted that the positional nystagmus (92542) component of the bundled 92540 requires that positional testing occur with a minimum of four positions (American Academy of Audiology, 2023). 

Saccades

Saccadic testing is routinely completed as part of ENG and VNG procedures, but the work of this procedure is not accounted for in the bundled 92540 (basic vestibular evaluation) code. There is no CPT code assigned to saccadic testing.  Therefore, 92700 (other otorhinolaryngological service or procedure) can be used to bill for this procedure, and the fee is set by the provider. Code 92770 (electro-oculography) should not be used to report saccadic testing as 92770 is an ophthalmology code and can only be used to document a standard test of the electrical potential originating in the retina.  

Use of Modifier for Incomplete ENG/VNG Testing

In vestibular assessment, clinicians may find that there are times where the entirety of the bundled, basic vestibular evaluation (92540) cannot be completed due to equipment or patient factors (for example, nausea or inability of VNG equipment to track eye movements due to severe ptosis). When 92540 (basic vestibular evaluation) is not completed as intended in the bundled code description, clinicians should report only the component codes of 92540 that were completed and append a -59 (distinct procedural service) modifier to each component code. When two to three of the component procedures of 92540 are completed, those services may be reported (that is, any 2 or 3 among codes 92541, 92542, 92544, 92545) and the -59 modifier appended to each. Documentation in the medical record should indicate why the bundled code (92540) was not performed (American Academy of Audiology, 2023).