Otolaryngology Coding Alert

News flash: Goggle placement doesn't count as 92547

Sure, you want payment when your otolaryngologist places goggles prior to measuring a patient's eye movement, but you shouldn't report 92547 for this service.

Dilemma: Coders don't know whether they should apply the same add-on "placement" code when their otolaryngologist performs nystagmography (NG) with video rather than electrodes. Experts explain how you should code each method.

92547 Is for Electrode-Based System

When your otolaryngologist places electrodes, you should bill +92547 (Use of vertical electrodes [list separately in addition to code for primary procedure]) per service date. Otolaryngologists have traditionally obtained electronystagmography (ENG) (92541-92546) responses with electrodes.

But otolaryngologists could observe only limited torsional eye movement with electrodes. Increasingly, otolaryngologists are using infrared technology to record eye movements, especially when diagnosing benign paroxysmal positional vertigo (386.11, Vertiginous syndromes and other disorders of vestibular system; other and unspecified peripheral vertigo; benign paroxysmal positional vertigo).

Video Method Makes 92547 Billing Improper

You shouldn't assign 92547 when your otolaryngologist uses the new "video" technology. "Code 92547, as stated in the code descriptor, is specific to the use of vertical electrodes," says Jennifer Trajkovski, BS, RHIT, coding associate for AMA CPT Information Services in a private letter.

Problem: In videonystagmography (VNG), the otolaryngologist doesn't apply electrodes, says James Z. Cinberg, MD, a solo-practice otolaryngologist in Elizabeth, N.J. The physician instead places goggles over the patient's eyes.

Bottom line: Because VNG uses video to record and measure the patient's eye movement instead of vertical electrodes, you should not submit 92547 for goggle use, says Robert Henderson, president of Vestibular Technologies in Tampa, Fla.

Payment Isn't Worth Risk

If you're thinking of still billing 92547 for VNG, don't. Insiders have reported rumblings that the Office of Inspector General may target vertical electrode code use.

In any case, improperly using 92547 probably isn't worth the extra $45.18 (2004 Medicare national value) that the code pays, Henderson says.