Neurology & Pain Management Coding Alert

Question: Encounter notes indicate that the physician performed an electronystagmography (ENG) for a patient experiencing visual problems and occasional dizziness. How should I report this service?

Washington Subscriber

Answer: You’ll need more information before you can choose the correct ENG code — or codes. ENG is broken down into four separate evaluations/measurements:

• 92541, Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording
• 92542,  Positional nystagmus test, minimum of 4 positions, with recording  
• 92544, Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording
• 92545, Oscillating tracking test, with recording.

The rub: There is also another ENG code that you’d use when the physician performs all four of the above-listed tests: 92540 (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).

Do this: Go back and check to see how many of the ENG evaluations/measurements the physician performed. If he performed all four, report 92540 for the service. If, however, he only performed one, two, or three of the evaluations/measurements, you can still report the service(s) with modifier 59 (Distinct procedural service) appended to any secondary code(s). For example, let’s say the physician performs a spontaneous nystagmus test and a positional nystagmus test with five positions. On the claim, you would report 92541 for the spontaneous test and 92542-59 for the positional test.