# Vng



## NESmith (Sep 6, 2012)

Please help coding this report. There is a slight disagreement about the codes being billed.
                                           Videonystagmography
Tracking/Smooth Pursuit, Saccade, Optokinetic, Gaze Testing, Spontaneous Nystagmus, Torsion Swing, Active Head Rotation, Positional Tests, Dix/hallpike Tests, caloric Results testing were performed with vertical as well as horizontal recordings.
                                            Oculomotor Studies
Tracking/Smooth Pursuit:
For a patient of this age, normative values for gain range from 55-155. This patient elicited 67 gain & o phase. There is normal gain and phase horizontally.
Saccade:
For a patient of this age, normative peak velocity is greater thatn or equal to 210 deg/sec and latency less thatn or equal to .380. This patient has elicited 358 deg/sec velocity and .400 latency. Saccadic latency is increased.
Optokinetic:
Normative values for optokinetic nystagmus studies are greater than or equal to 6 deg/sec to each side with a symmetrical difference of greater than equal to 30%. This patient has elicited 9L deg/sec rightward and 7R deg/sec leftward. Optokinetic nystagmus is normal and symmetrical bilaterally.
Gaze Testing:
Study is normal.
Spontaneous Nystagmus:
Normal values for hrizontal slow componet velocity are 0-3 deg/sec. This patient elicited OR deg/sec horizontal slow component velocity. none was elicited.
Torsion Swing:
This test is normal. There was adequate fixation suppression.
                                    Active Head Rotation
Active head rotation was performed at head speeds of 1-2 Hz. for both  the vertical and horizontal vestibulo-ocular reflex(VOR).
Normative values for gain both horizontally and vertically are 75-125% with horizontal asymmetry within +/-10%. This patient elicited horizontal gain of 100R% and vertical gain of 42R%. there is decreased VOR gain vertically. There is normal gain horizontally. There is normal horizontal gain symmetry.
                                    Positional Test
Normative values for positional tests are 0-3 deg/sec horizontal slow component velocity for all positions. Patient elicited the following values for positional test.
Surpine, Head C  Supine, Head L  Supine Head R  Body L  Body R
         3L                      3R                    5L             11R       6L
Positional nystagmus is present with supine, head position to the right. Positional nystagmus is present with left-lateral, decubitus positioning. Positional nystagmus is present with right-lateral, decubitus positioning.
                                     Dix/Hallpike Test
Normative values for Dix/Hallpike tests are less than or equal to 3 deg/sec slow component velocity both horizontally and vertically.Patient has elicited 6L deg/sec horizontally and OR deg/sec vertically on rightward testing and 1R deg/sec horizontally and 3L deg/sec vertically on leftward testing. There is paroxysmal positional ageotropic torsional nystagmus with right ear undermost.
                                     Caloric Results
Normative values for caloric testing are a combined slow component velocity from all 4 tests(cool right, cool left, warm right, warm left) of greater than or equal to 20 deg/sec with a unilateral weakness of less than or equal to 25%. Patient has elicited the following results for caloric test;
Warm Left  Warm Right  Cool Left  Cool Right
     10L            1R                OR          16L
There is left-sided unilateral weakness(>25%).
                                      Impression:
Peripheral
There is evidence of significant peripheral vestibular dysfunction. Positive Dix/Hallpike maneuver with ageotropic torsional nystagmus after brief latency denotes canalithiasis or cupulolithiasis involving the contralateral anterior semicircular canal. This is suggestive of benign paroxysmal positional verigo. The clinician must determine if there is canalithiasis(more common) vs. cupulolithiasis(less common) by the latency of the nystagmus and clinically. Unilateral weakness denotes a lesion involong the horizontal semicircular canal or its afferent pathways on the side of the weaker response.
Central
There is evidence of significant central vestibular dysfunction. Delayed saccades denotes a lesion of the frontal or frontoparietal cortex or absal ganglia. These must be interpreted with caution;consider medications and inattention. Positional nystagmus is non-localizing and denotes peripheral or central vestibular dysfunction. Decreased VOR gain may denote central vestibular or oculomotor dysfunction.
                                      Recommendations:
Balance rehabilitation is indicated, targeting the above mentioned abnormalities. Canalith repositioning(e.g. Eppley) maneuvers are indicated. Audiologic testing may be indicated. the patient was tested under the direct supervision of...........M.D.

The technician has coded these procedures as such;
92541 x 1
92542 x 1
92542-76 x 1
92543 x 4
92544-59
92545 x 1
92545-76 x 1
92546 x 1
92546-76 x 1

We do not feel this correct. Please give your opinion of this report and coding. Thank You ever so much for your help in this matter.


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## aaron.lucas (Sep 6, 2012)

You are right that is not completely correct.  The 92543 is correct, that is billable for 4 units (each irrigation, 2 ears plus 2 temps hot and cold equals 4), however 92541, 92542, 92544 and 92545 may not all be billed together, this is unbundling.  You should use 92540, which is a combo test code that includes the four listed above.  The 92545-76 also is not correct, that is a once per day code as is 92546 (one unit includes testing in both directions).  There is some good news though, because vertical testing was done, you should be able to bill 92547 (vertical electrodes).  That should give you some extra revenue.  Hope that helps!


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## NESmith (Sep 7, 2012)

Thank You so much for your response arron.lucas. My thoughts exactly. I do have one other question, should we be billing these procedures global when tech from an outside company comes in to do the tests or should the provider only billing the procedures wiith a 26 modifier for the professional component?


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## aaron.lucas (Sep 7, 2012)

You're welcome.  If the doc doesn't own the equipment being used then yeah, should only bill -26 for interpreting the reports that the computer spits out.


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