Question
In regard to vestibular evoked myogenic potentials (VEMP), what's the current status with the the FDA? If VEMP has not yet been authorized by the FDA, is it ethical to do VEMP and to bill for it under an electrophysiology code?
Answer
Interesting timing for that question. I had a long discussion with several professionals recently about that very topic. Here is the situation, and it is a bit of a Catch-22. U.S.-based manufacturers are focusing their VEMP resources in Europe, where there is much greater demand, and therefore are not gathering data in the U.S. for the FDA. The manufacturers indicate that if we had a CPT code for VEMP, we can demonstrate to the FDA that is an accepted procedure. However, FDA approval of the procedure is required in order to approve a CPT code.
To answer the second part of your question, yes, it is ethical to perform VEMPs. There is enough literature out there to say that VEMP is diagnostically appropriate. Keep in mind I am not speaking on behalf of any organization. This is my own opinion, but there is quality literature available supporting the clinical efficacy of VEMP. The problem has been is that VEMP amplifiers and the VEMP protocol were adapted to ABR equipment by equipment manufacturers without clarifying with the FDA that VEMP was a totally different procedure. The FDA then said, “We need to make sure that this procedure is safe and efficacious.” That is where this discussion all began. The FDA review panel put forth some conditions that were unreasonable for the manufacturers to comply with. Although that has now changed, the manufacturers are not moving forward on this issue at the moment. But there is enough literature to support the ethics of performing VEMP.
So, how do you code it? The advice that we used to give was using 92585, which is the ABR code. That raised some eyebrows and brought up some questions, and so the audiology community and ENT community huddled together and an observation was made. The VEMP protocol is really not an ABR. If you are looking at purity of the CPT code, the VEMP does not meet the criteria of an ABR. We sent recommendations to the American Medical Association (AMA), and it was published in the CPT assistant publication by the AMA to use 92700, which is the unspecified procedure code for VEMP. That is now the official guidance, in agreement between audiology and ENT communities, on how to code VEMP.
Editor’s Note: This Ask the Expert was taken from the eSeminar Reimbursement: The 2012 Perspective published on 2/9/2012. To access the recorded course, please go to https://www.audiologyonline.com/audiology-ceus/course/practice-management-marketing-business-issues-reimbursement-the-2012-perspective-19955
