Otolaryngology Coding Alert

Question: We bill a random saccade test for dizziness or vertigo with an unlisted-procedure code. But Medicare and Blue Cross Blue Shield bundle the code with any other same-day charges. I don't understand how insurers can bundle an unlisted-procedure code. Am I coding the test correctly?

Florida Subscriber

Answer: You should actually code a random saccade test with a specific CPT code: 92545 (Oscillating tracking test, with recording). Even though 92545's code descriptor doesn't specifically mention a random saccade, fixed-amplitude saccade, or smooth pursuit test, you should report all these tests as 92545.
 
Otolaryngologists order these tests to assess a patient's ability to track an object. Therefore, the service falls under 92545's descriptor of "tracking test."
 
Using 92545 with the audiologist's findings, such as Meniere's disease (for instance 386.03, Active Meniere's disease, vestibular), rather than 92700 (Unlisted otorhinolaryngological service or procedure), should alleviate your reimbursement problems. The 2005 National Physician Fee Schedule Relative Value File lists 92545 as an active code. Medicare assigns 1.06 total relative value units to 92545. If an audiologist performs the test in the otolaryngologist's office (place of service 11), Medicare pays 92545 at a national rate of $40.17 (1.06 RVUs x $37.8975 conversion rate).
 
In contrast, 92700 payment depends on the insurer. Because the code is for an unlisted procedure, each carrier determines coverage for the non-CPT defined procedure.