Otolaryngology Coding Alert

Good news: VNG accessory coding may be down the pike

If you think that 92547 hasn't been updated to reflect new video technology instead of electrode use, you-re dead-on. But non-codability for goggle use could soon be changing. Until then, get a handle on this code's hook-up requirements.

The AMA and American Speech-Language-Hearing Association (ASHA) are clear on coding for nystagmography (NG), so your correct coding depends on applying +92547 (Use of vertical electrodes [list separately in addition to code for primary procedure]) to the appropriate machinery. Here's how to avoid overextending the code.

Check the Hook-up Details

When your otolaryngologist orders NG to track a patient's eye movements, find out the accessory that the test involves. The answer determines whether you can capture an additional $5.68 (the 2007 Medicare Physician Fee Schedule assigns 0.15 transitional nonfacility total relative value units to 92547).

-Our audiologists use the fully electronic computerized ENG machine,- says Candice Ruffing, CPC, with Drs. Berghash & Lanza PL in Florida and education officer for the American Academy of Professional Coders Sailfish Chapter in Port St. Lucie. The audiologists -do not use physical electrodes, but they do hook the patient up to the computer.- Can they bill 92547?

Limit 92547 to Electrode Use

You should not code for goggle placement used for videonystagmography (VNG) with 92547. To bill 92547, -the equipment you are using MUST employ vertical electrode technology,- electronystagmography (ENG, 92541-92546), states the Multi-Disciplinary Academy of Affiliated Medical Arts (MAAMA) in its Sept. 14, 2005, Special Alert on Vestibular Testing. -Under an opinion from the AMA (which is on file at the Academy office), billing -video- technology under code 92547 is IMPROPER,- the alert says.

Why: The practice expense (PE) assigned to 92547 for using vertical electrodes is factored on that activity, not goggle use. The intra-service time includes a specific description of activities that justify, minute by minute, the length of time requested for the code's PE valuation, says Robert C. Fifer, PhD, director of audiology and speech-language pathology in -Coding for Vertical Electrodes,- published by AudiologyOnline. Although repeated calibration is common to both setups, the time required for electrode application and either the repeated stimulation or the additional analysis time for the vertical electrodes has not been described for the goggles in a specific code.

Rule Out 92700 for Goggle Application

Do not alternatively report goggle use with 92700 (Unlisted otorhinolaryngological service or procedure). ASHA does not support 92700 when using VNG, says Steven C. White, PhD, CCC-A, director of healthcare economics and advocacy at ASHA in Rockville, Md.

Take heart: ASHA hasn't ignored your concern that no CPT code exists for goggle use. -We will continue to develop the proposal for a VNG family of codes so that this issue will become a moot one,- White says.