Question
What CPT codes should be used for subtests such as head shaking, hyperventilation induced nystagmus, or vibration induced nystagmus. What is the appropriate code for the canalith repositioning maneuver? Is it improper to bill for the vertical electrode component of the ENG test if you are performing the test with videonystagmography equipment?
Answer
With regard to the head shake test, hyperventilation induced nystagmus, and vibration induced nystagmus, there are no codes for these procedures. The appropriate manner of reporting these codes is to use the new code 92700 (unspecified otolaryngology procedure) and accompany this code submission with a detailed report. The elements of the report should include the presenting symptoms of the patient, what these procedures are and their diagnostic usefulness (i.e., a complete description of what it is and what you did), what you found and from that information what do you recommend. It would not hurt to include two or three articles from the peer-reviewed professional journals to convince them that this is a good thing despite the absence of a specific code. Also, don't assume that they will be familiar with the terms. It is very rare that they have any idea of what we do. For canalith repositioning, again there is no CPT code for this procedure. I am aware that some physical therapists who do the procedure are billing 97530 as one possibility. That code is labeled ''Therapeutic activities'' with a broad descriptor that could lend itself to repositioning. With regard to billing for vertical electrodes when using videonystagmography recordings, if you are using caloric stimulation with horizontal and vertical electrode recordings, you are limited to billing a maximum of four times CPT code 92543 for a single date of service. This is an editorial footnote issued by Medicare that many private payers have picked up. However, for a non-Medicare or non-Medicaid payer, it could be worthwhile to talk to them to see if they will allow billing the additional recordings. They would need to know what additional diagnostic value the vertical axis recordings would bring to the picture, not simply that it is an improvement in technology to enhance your ability to record. I can assure you that they don't care about that. If you have specific examples where it was of tremendous value in rendering a diagnosis, then use that (without any patient identification) to convince them that the extra recordings and extra charges are worth their extra expense. If you are using the video recordings for Dix-Hallpike (for example), then you must use simple the positional assessment code in the vestibular section. Generally there is not an accommodation for extra charges because you place additional electrodes on the head.
Bob Fifer
Robert C. Fifer, Ph.D.
Director of Audiology and Speech-Language Pathology
Mailman Center for Child Development
1601 NW 12th Avenue
Miami, FL 33101
