Neurology & Pain Management Coding Alert

Question: Our neurologist wants to bill several nystagmus test codes for the same session but I'm wondering if some can't be billed together. He wants to submit each of these codes with modifier 26:

• 92540
• 92541
• 92542
• 92543 x 4
• 92544
• 92545

What do you recommend?

Vermont Subscriber

Answer: According to CPT® parenthetical notes, you cannot bill some of these codes together. Start with 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). Once you report 92540, you cannot bill 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), or 92545 (Oscillating tracking test, with recording). Additionally, current NCCI edits bundle codes 92541, 92542, 92544, and 92545 into the comprehensive 92540 code. The modifier indicator of "0" indicates that you cannot use a modifier to bypass the edits for any reason.

You can include 92543 (Caloric vestibular test, each irrigation [binaural, bithermal stimulation constitutes 4 tests], with recording) with 92540. Don't forget to bill for each irrigation, as indicated in your physician's notes as the CPT® code is based on "each irrigation" and often means billing for four units of service.

Definition: Nystagmus is an involuntary rhythmic shaking or wobbling of the eyes. There are more than 45 types of nystagmus, traditionally divided into two groups. Sensory nystagmus is related to vision loss and motor nystagmus is related to the control of muscle function.