Otolaryngology Coding Alert

You should only report one unit of 92545.

When the patient complaining of headaches shows vestibular signs, the ENT may order a vestibular test (92541-92548). Usually an audiologist or a qualified otolaryngology technician would perform the technical portion of the evaluation, while the ENT, PA, or nurse practioner provides direct supervision and later furnish the interpretation.

Definition: Vestibular tests are tests of function. It aims to determine if something is wrong with the vestibular portion of the inner ear. If dizziness is not caused by the inner ear, it might be caused by disorders of the brain, by medical disorders such as low blood pressure, or by psychological conditions such as anxiety.

When ordering vestibular tests, make sure the physician documents the service’s professional component, which include clinical decision- making and other active participation in the delivery of the service, according to CMS Transmittal 84. The documentation should include such details as:

the technician's name and professional identity;

the specific tests the physician ordered; direct supervision and interpretation by the nonphysician practitioner (NPP) or physician.

Direct supervision means the physician or NPP under which the test is being billed is in the office suite when the test is performed. The physician or NPP need not be in the room with the patient and the technician. If an audiologist performs the vestibular testing, the service is billed out under the audiologist’s NPI and there is no supervision requirement by the physician or NPP.

Example: An otolaryngologist orders a qualified technician to perform an oscillating tracking test (92545, Oscillating tracking test, with recording). The physician directly supervises, and interprets the result. On your claim, you would report the following:

·         92545 with no modifier because both the technical component and the professional component are performed by the same practice.  The two components are not broken out separately.

When reporting 92545, you should limit the units to one. Why? In 92545, the audiologist asks the patient to move only his eyes. The audiologist does not do anything but instruct while the patient stays still in one spot.

What happens: This test comprises two types: the smooth pursuit and the saccadic test. The smooth pursuit test evaluates the ability of the patient to keep a moving visual target registered on the fovea. The patient watches a moving target as it moves back and forth in a smooth pendular fashion. The saccadic test evaluates the ability of the patient to find a moving target and tests certain CNS neural integrators. A computer calculates the gain, and compares it to age matched norms.