Audiologists May Bill Several Vestibular Codes A change in Medicare policy will allow audiologists and other health care professionals to bill two or three vestibular testing codes for the same patient on the same day, a change that follows months of lobbying by ASHA and other organizations. The change takes effect Oct. 1, 2010, for individual ... Bottom Line
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Bottom Line  |   August 01, 2010
Audiologists May Bill Several Vestibular Codes
Author Notes
  • Steven C. White, PhD, CCC-A, director of health care economics and advocacy, can be reached at swhite@asha.org.
    Steven C. White, PhD, CCC-A, director of health care economics and advocacy, can be reached at swhite@asha.org.×
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Balance & Balance Disorders / Practice Management / Regulatory, Legislative & Advocacy / ASHA News & Member Stories / Bottom Line
Bottom Line   |   August 01, 2010
Audiologists May Bill Several Vestibular Codes
The ASHA Leader, August 2010, Vol. 15, 4. doi:10.1044/leader.BML2.15102010.4
The ASHA Leader, August 2010, Vol. 15, 4. doi:10.1044/leader.BML2.15102010.4
A change in Medicare policy will allow audiologists and other health care professionals to bill two or three vestibular testing codes for the same patient on the same day, a change that follows months of lobbying by ASHA and other organizations.
The change takes effect Oct. 1, 2010, for individual practitioners and Jan. 1, 2011, for outpatient facilities.
According to current Medicare regulations, providers may bill a “bundled” CPT (Current Procedural Terminology, ©American Medical Association) code that includes four vestibular tests. That bundled code (92540, Basic vestibular evaluation) includes codes 92541, 92542, 92544, and 92545. Providers also may bill for any one of those codes; however, they may not bill for any combination of two or three of the codes (see The ASHA Leader, April 6, 2010).
ASHA and other groups questioned this regulation, and lobbied the Centers for Medicare and Medicare Services (CMS) to correct what they believe are erroneous edits in the National Correct Coding Initiative (NCCI) that established the current rule. CMS would not revise its policy until CPT published a correction to the parenthetical limitations for the vestibular test codes. Now that the CPT error has been changed, CMS will correct the NCCI edits, allowing Medicare billing of combinations of three or fewer of test codes 92541 (spontaneous nystagmus), 92542 (positional nystagmus), 92544 (optokinetic nystagmus), and 92545 (oscillating tracking).
According to CMS, “If two or three of these codes are reported for the same date of service by the same provider for the same beneficiary, an NCCI-associated modifier may be utilized to bypass the NCCI edits.” The “-59” (distinct procedural service) modifier should be used when the edits take effect.
The American Medical Association CPT errata page posted corrections on July 22, 2010, that describe the appropriate reporting of the individual vestibular testing codes:
  • 92541 Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording (do not report 92541 in conjunction with 92540 or the set of 92542, 92544, and 92545).

  • 92542 Positional nystagmus test, minimum of four positions, with recording (do not report 92542 in conjunction with 92540 or the set of 92541, 92544, and 92545).

  • 92543 Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes four tests), with recording.

  • 92544 Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording (do not report 92544 in conjunction with 92540 or the set of 92541, 92542, and 92545).

  • 92545 Oscillating tracking test, with recording (do not report 92545 in conjunction with 92540 or the set of 92541, 92542, and 92544).

  • 92546 Sinusoidal vertical axis rotational testing.

For more information, contact reimbursement@asha.org.
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August 2010
Volume 15, Issue 10