Question
We are considering performing VEMPs in our otologist's office but are unsure how to bill for it. Do you know if there is a CPT that can be used and if this is normally covered by insurance plans?
Answer
Thanks for your question. Generally speaking, I currently recommend using 92585 (auditory evoked potentials, comprehensive) for the VEMP.
Please do note that if you are performing other AEP measures on the same date, you can bill 92585 only once on that date of service. This is the same as if you would perform a ABR and ASSR, or an ABR and a MLR on the same date, you can only bill 92585 once on that date. As a historical reference, a few years ago we tried to get the AMA to allow us more time (and the ENTs and Neurologists were right there with us), but both the AMA and CMS would not go for it. A new code just for VEMP is on the drawing board, but we are working to get through some other codes that are of higher priority at the moment.
You also need to carefully consider the diagnosis code. I would not be surprised that a third party payer would look at a balance/vestibular diagnosis code as a mismatch with an evoked potential procedure code.
The reason for this is that we are not diagnosing dizziness, but some aspect of auditory / neural function. I know the VEMP is more end organ vestibular, but the downfall of the coding system is that the ICD-9 series in particular is severely lacking in precision. I would offer the suggestion of a non-dizziness code (e.g., Hearing loss, central; 388.9 - unspecified disorder of the ear). But if you have done an ABR on the same day, I would go with one of our 389 family of diagnosis codes if appropriate. The dizziness brought them to you, your diagnosis code must be derived based on what you find from your test results.
Robert C. Fifer, Ph.D. is currently the Director of Audiology and Speech-Language Pathology at the Mailman Center for Child Development, Department of Pediatrics, University of Miami School of Medicine. He received his B.S. degree from the University of Nebraska at Omaha in Speech-Language Pathology with a minor in Deaf Education. His M.A. degree is from Central Michigan University in Audiology. And his Ph.D. degree is from Baylor College of Medicine in Audiology and Bioacoustics. Dr. Fifer's clinical and research interests focus on the areas of auditory evoked potentials, central auditory processing, early detection of hearing loss in children, and auditory anatomy and physiology. He is the current President of the Florida Association of Speech-Language Pathologists and Audiologists, a member of ASHA's Health Care Economics Committee, and the ASHA representative to the American Medical Association's Health Care Professions Advisory Committee for the Relative Value Utilization Committee in addition to being ASHA's representative to the AMA's Practice Expense Advisory Committee. Additional responsibilities at the state level include serving as a consultant to the Florida Department of Health's Children's Medical Services and the audiology representative to the Genetics and Newborn Screening Advisory Council.
