Otolaryngology Coding Alert

Question: The otolaryngologist performs a caloric vestibular test with recording. Two warm and two cold calorics are used in the test. We have been billing four units for this service, but one local payer is telling us we can only bill one unit because the CPT code states that the service "constitutes four tests." Are they correct?

Wisconsin Subscriber

Answer: You have been billing the service correctly, and the carrier is in error.
 
The descriptor for 92543 makes it clear: caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes four tests), with recording. The key words in the descriptor are "each irrigation."
 
The terminology inside the parentheses simply describes a typical test that checks each ear for warm and cold calorics.
 
In some cases, a third test with ice may be performed on both ears. When this occurs, six units should be billed.
 
Note: Some carriers do not recognize units and may require 92543 be billed four times on four separate lines. In such cases, modifier -59 (distinct procedural service) should be appended to 92543 on lines two through four, as follows: 92543, 92543-59, 92543-59, 92543-59.