Otolaryngology Coding Alert

Verify the correct number of codes to include.

An otolaryngologist or audiologist will sometimes perform a vestibular evaluation, or electronystagmography (ENG), if a patient is experiencing vertigo or other conditions that can affect hearing and vision. The next time you’re coding one of these tests, follow three simple steps to a successful filing.

Step 1: Choose the Evaluation Code

ENG is actually a collection of tests that can include one or more measurements. The four foundational evaluation codes are:

• 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.

A fifth code in CPT^® represents all of the services for codes 92541-92545. This “complete service” code is 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).

Important: You can report up to three individual component codes for the ENG. If your provider performs all four components, submit 92540 instead of the separate codes. Coding edits bundle 92542, 92544, and 92544 into 92541, but you can override the bundle and bill both procedures by appending modifier 59 (Distinct procedural service) to the secondary, or component, code. 

It is not unusual for 92541 and 92542 to be performed on the same date of service, so they can be billed as 92541 and 92542-59 for the same date of service if those were the only two test components of 92540 performed.

Step 2: Report Caloric Testing and/or Electrodes

When looking at the test documentation, be on the lookout for other services you can report separately.

Example 1: A caloric test can be given in conjunction with the ENG to possibly discover the degree to which the vestibular system is responsive and also how symmetric the responses are, between left and right ears. If you have documentation of a caloric test, report 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]) or 92538 (…monothermal [i.e., one irrigation in each ear for a total of two irrigations]) depending on the number of irrigations in each ear. 

“The codes for irrigations have changed with 2016 CPT^®,” reminds Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, vice president at Stark Coding & Consulting, LLC, in Shrewsbury, N.J. “With the new codes described above, we no longer report units.”

Example 2: If your provider uses vertical electrodes during the test, you can report this in addition to the procedure itself. Include add-on code +92547 (Use of vertical electrodes [List separately in addition to code for primary procedure]) on the claim for each test performed. However, do not report +92547 when a VENG (video ENG) is performed, because that test does not use electrodes.

Step 3: Pay Attention to the Provider

The final step of your coding is to assign performance-associated modifiers, if necessary. The specifics will depend on who administers the test.

Qualified audiologist: Report all test codes using the audiologists NPI. You will not append modifier 26 (Professional component) or modifier TC (Technical component).

Technician supervised by a physician: “These are the few codes that may be performed by an oto technician,” Cobuzzi says. “When these are performed by the oto technician, submit the appropriate codes under the physician’s NPI. Remember the technician can perform the technical component of the test but cannot interpret the results. That will be completed by the physician. Report the technician’s service with modifier TC and the physician’s with modifier 26.”