Billing and Coding Information for the Balance+Plus Fall Assessment Systems

VESTIBULAR FUNCTION TESTS WITH RECORDING (E.G., VNG & ENG) AND MEDICAL DIAGNOSTIC EVALUATION

 

Following each code are three descriptions of various tests done with Balance+Plus Fall Assessment instrumentation.

 

  • Name of the test as listed in the CPT codes.
  • A single sentence often used in medical billing.
  • A rather long paragraph would be appropriate for appending to a super bill.
  •  

     

    Basic Vestibular Evaluation

    CPT 92540 (New Bundled Code)

    Basic Vestibular Evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording.

    NOTE: For Medicare, use this bundled code. For commercial carriers, you may be allowed to use for following codes: 92541, 92542, 92544 and 92545 instead.



    Nystagmus

     

    CPT 92541
    Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording

     

    Brief:
    These nystagmus tests document and measure the inability of the eyes to maintain a static position as a result of peripheral, CNS or congenital abnormality.

     

    Extended:
    These nystagmus tests document and measure the inability of the eyes to maintain a static position as a result of peripheral, CNS or congenital abnormality.  The tests are conducted with the eyes open and closed and in 'eyes forward' as well as 'eyes right' and 'eyes left' positions.

     

     

    Positional Nystagmus

     

    CPT 92542
    Positional nystagmus test, minimum of four positions, with recording

     

    Brief:
    These spontaneous nystagmus tests document and measure the inability of the eyes to maintain a static position when the head is in different positions.

     

    Extended:
    These spontaneous nystagmus tests document and measure the inability of the eyes to maintain a static position when the head is in different positions. These tests are valuable to document and quantify patient complaints of dizziness in certain situations or positions. Moreover, they are sometimes helpful to localize the abnormality as CNS or peripheral.

     

     

    Calorics (optional caloric equipment needed to provide this service)

     

    CPT 92537
    Caloric vestibular test with recording, bilateral; bithermal (i.e., one warm and one cool irrigation in each ear for a total of four irrigations) (Irrigations can be water or air.)

    (Do not report 92537 in conjunction with 92538).
    (For three irrigations [like 2 warm and 1 cool], use modifier -52 in the following states: Florida, Puerto Rico, Virgin Islands, South and North Carolina, West Virginia and Virginia)
    (For monothermal caloric vestibular testing, use 92538)

    CPT 92538
    Caloric vestibular test with recording, bilateral; monothermal (i.e., one irrigation (warm or cool) in each ear for a total of two irrigations)

    (Do not report 92538 in conjunction with 92537)
    (For one irrigation [i.e., only warm or cool in one ear], use modifier -52 in the following states: Florida, Puerto Rico, Virgin Islands, South and North Carolina, West Virginia and Virginia)
    (For bithermal caloric vestibular testing, use 92537)

    Note: CPT codes 92537 and 92538 may not be billed more than once on the same date of service. To report more than irrigations than indicated in each code, consider using the modifier -22 to indicate an increased service. In those circumstances, audiologists should be prepared to provide justification for the increased service and why it was needed.

     

     

    OKN or OPK

     

    CPT 92544
    Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording

     

    Brief:
    The Optokinetic test documents and measures eye movements as the patient watches a series of targets moving simultaneously.

     

    Extended:
    The Optokinetic test documents and measures eye movements as the patients watches a series of targets moving simultaneously to the right and then to the left. The Optokinetic mechanism is at work when the visual movement in one direction encompasses more than a single point.


     

    Tracking or Smooth Pursuit

     

    CPT 92545
    Oscillating tracking test, with recording

     

    Brief:
    This test evaluates the ability of the patient to keep a moving visual target registered on the fovea.

     

    Extended:
    This test evaluates the ability of the patient to keep a moving visual target registered on the fovea. The patient watches a light as it moves back and forth in a smooth pendular fashion. The computer computes the gain (target velocity divided by eye velocity) and compares the gain to age matched norms.


     

    VORT - Active Head Rotation

     

    CPT 92546
    Sinusoidal vertical axis rotational testing

     

    Brief:
    This is a computerized slow harmonic acceleration rotational test of the Vestibulo-Ocular Reflex (VOR), the neural mechanism that keeps a visual image registered on the fovea during head movement.

    Extended:
    This is a computerized test of the Vestibulo-Ocular Reflex (VOR), the neural mechanism that keeps a visual image registered on the fovea during head movement. It evaluates the three functional components of the VOR system: the peripheral end organ, the vestibular nuclei of the brain stem and the higher central vestibular connections. The test is accomplished by having the patient shake his head "no" and "yes" while wearing EOG electrodes or VNG googles that monitor eye position and a small angular velocity sensor that measures head velocity. From this data the computer computes three characteristics of the VOR: gain (ratio of eye velocity to head velocity), phase (the number of degrees by which the eye ‘misses' the target), and asymmetry (a comparison of gain moving right with gain moving left). This information is useful for evaluating patients with balance disorders.

     

     

    Dynamic Posturography (Fall Assessment System)

     

    CPT 92548
    Computerized Dynamic Posturography

     

    Description:
    This is a computerized test that allows various systems that contribute to equilibrium to be assessed.

     

    CPT 97750
    Physical performance test or measurement (e.g. musculoskeletal, functional capacity) with written report, each 15 minutes.

     

     

    Therapy Codes (Fall Assessment Training System)

     

    CPT 97110
    Therapeutic procedure 1 or more areas, each 15 minutes, therapeutic exercise to develop strength, range of motion

     

    CPT 97112
    Neuromuscular reeducation of movement, each 15 minutes

     

     

    Other Rehabilitative Codes for Use with Vestibular Rehabilitation Therapy (VRT)

     

    CPT 97530
    Therapeutic activities, direct (one on one) patient contact by the provider (use of dynamic activities to improve functional performance) each 15 minutes.

     

    CPT 97532
    Development of cognitive skills to improve attention, memory, problem solving, includes compensatory training and / or sensory integrative activities, direct (one on one) patient contact by the provider, each 15 minutes.

     

    CPT 97535
    Self care / home management training (e.g. activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of adaptive equipment) direct (one on one) contact by provider, each 15 minutes.

     

    CPT 97537
    Community / work reintegration training (e.g. shopping, transportation, money management, avocational activities and / or work environment / modification analysis, work task analysis), direct (one on one) contact by provider, each 15 minutes

    CPT 97750
    Physical performance test or measurement (e.g. musculoskeletal, functional capacity) with written report, each 15 minutes.


    EXAMPLE CODING FOR FALL ASSESSMENT TESTING (BALANCE PLATFORM)*

    CPT Code

    Modifier

    Units

    Description / (Which Plans To Use It With Below)

    92548

     

    1

    Posturography

    92548

     

    1

    (Medicare/Medicaid/Replacement Plans/Worker's Comp/PIP)

    97750

     

    1

    Physical Performance Test

    97750

     

    1

    (Aetna/Cigna/Commercial Carriers, if they deny 92548)



    EXAMPLE CODING FOR MEDICARE (IF DOING ALL THE TESTS)*


    CPT Code

    Modifier

    Modifier

    Units

    Description

    92540

     

     

    1

    Basic Vestibular Evaluation (bundled code)

    92537

     

     

    1

    Caloric vestibular test with recording, bilateral; bithermal

    92546

     

     

    1

    Sinusoidal vertical axis rotational testing

    92546

    59

     

    1

    Sinusoidal vertical axis rotational testing



    EXAMPLE CODING FOR COMMERCIAL INSURANCE (FOR VNG & CALORIC)*


    CPT Code

    Modifier

    Modifier

    Units

    Description

    92541

     

     

    1

    Spontaneous nystagmus test

    92542

    59

     

    1

    Positional nystagmus test

    92537

     

     

    1

    Caloric vestibular test with recording, bilateral; bithermal

    92544

    59

     

    1

    Optokinetic nystagmus test

    92545

    59

     

    1

    Oscillating tracking test

    92545

    59

    76

    1

    Oscillating tracking test

    92546

     

     

    1

    Sinusoidal vertical axis rotational testing

    92546

    59

     

    1

    Sinusoidal vertical axis rotational testing


    ICD-10 DIAGNOSIS CODES

    Click here to view the diagnosis codes for the BASIC Fall Assessment tests.

    Click here to view the diagnosis codes for the COMPREHENSIVE Fall Assessment tests.

     

    * Disclaimers:

      Procedure coding should be based upon medical necessity and procedures and supplies provided to the patient.

      Reimbursements are based on 2016 Medicare rates.  For up to date Medicare rates listed by CPT code consult the following website:
      http://www.cms.gov/apps/physician-fee-schedule/license-agreement.aspx

      Financial calculations are provided for illustration purposes only. You are responsible for verifying the accuracy and suitability of all assumptions and calculations.

      Coding, reimbursement and revenue information is provided for educational purposes and does not assure coverage, nor is it a guarantee of service in any given case.

      Contact your local Medicare Fiscal Intermediary, Carrier or CMS for specific information as payment rates listed are subject to change.

      Be sure to read the Healthcare Covenants in the purchase agreement regarding your due diligence responsibilities.

      Please seek the advice of licensed and/or competent individuals before making any investment decisions.

      Innovative Healthcare makes no guarantee of reimbursement of fees or lease/loan rates.

     

    What You Can Earn Providing Fall Risk Assessment & VNG Testing...