Neurology & Pain Management Coding Alert

Question: How many units can we report for each electronystagmography (ENG) and videonystagmography (VNG) service our neurologist performs?


New Mexico Subscriber


Answer: As a rule of thumb, you-ll reach your billing limit at one unit of 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) and 92545 (Oscillating tracking test, with recording) per patient visit.

Example: You perform a positional nystagmus test with multiple positions, including supine with the head extended dorsally, left, right and sitting. You should take your lead from the descriptor for 92542 and only report one unit because a minimum of four positions is required. If you use fewer than four positions, append modifier 52 (Reduced services) for an accurate reflection of the service performed.
 
Exception: You can once again take your billing cue from the descriptor of 92543 (Caloric vestibular test, each irrigation [binaural, bithermal stimulation constitutes four tests], with recording), and report up to four units. In this test, the neurologist irrigates the ear with warm and then cold water. If she performs the irrigation on each side (binaural) with dual temperatures (bithermal), you should report all four irrigations.