Otolaryngology Coding Alert

Question: Encounter notes indicate that the otolaryngologist performed an electronystagmography (ENG) for a patient experiencing visual problems and occasional dizziness. How should I report this service?

Washington, D.C. Subscriber

Answer: You’ll need more information before you can choose the correct ENG code — or codes. ENG is broken down into four separate evaluations/measurements:

• 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)

The rub: There is also another ENG code that you’d use when the otolaryngologist performs all four of the above-listed tests: 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).

Do this: Go back and check to see how many of the ENG evaluations/measurements the otolaryngologist performed. If they performed all four, report 92540 for the service. If, however, they only performed one, two, or three of the evaluations/measurements, you can still report the service(s) with modifier 59 (Distinct procedural service) appended to any secondary code(s). For example, let’s say the otolaryngologist performs a spontaneous nystagmus test and a positional nystagmus test with five positions. On the claim, you would report 92541 for the spontaneous test and 92542-59 (or XU for non-overlapping for Medicare Part B and any other payer who recognizes the X[ESPU] modifiers for separate procedures) for the positional test.