Wiki CPT 92537

[mfournier]

Hello Everyone:

I'm new to this specialty coding and was wondering if someone can take peek at this note to see if supports 92357/26/52?

I only see cool solution and not warm
Also it appears the test can only be done in one ear?

History of Present Illness:
He was referred by Dr XXX in neurology for vestibular testing. He noted episode of vertigo on Thanksgiving 2024 . He was spinning and playing with his granddaughter when this began. The intense portion of vertigo lasted hours, accompanied with nausea, stayed still for about an hour with eyes closed. Then could move but felt poorly. Did not eat on Thanksgiving. Had a mild headache and felt unwell. He has gotten better over months, but he still feel that if he turns quickly with his head, or rolling over in bed, or looking upwards, that the vertigo will come back. Most recent episode was yesterday, lasting seconds. He has a history of this occurring in the past once before in his 30's and it lasted about 6 weeks. He has hearing loss in RIGHT ear from childhood. Has chronic ringing in the ear, and it is more intense when he has vertigo. He denies any acute numbness, weakness, slurred speech incoordination etc with this vertigo. Meclizine helps with his symptoms. No history of migraine, but does not headaches after his vertigo episode. He notes hearing loss and tinnitus in both ears, and tinnitus increases with vertigo.

MRI brain scheduled for 4/11.

Test Results:
AMB AUD Vestibular Test Battery1:
Nystagmus: No Nystagmus
Gaze Nystagmus: No Nystagmus
Saccades:: Normal
Pursuit Tracking:: Sinusoidal
High Freq Head Shake Test:: Negative
Positional Testing:: Modif.Dix-Hallpike Neg for BPPV and Static-No Nystagmus
Calorics:: Abnormal (cool only 37% right stronger, total of 35deg/sec)
Sinusoidal Vertical Axis Rotation: VOR Gain Normal, VOR Phase Lead-Normal and VOR Symmetry Normal
Visual Vestibular Interaction: OKN Normal and Fix Normal



Impression:
Patient unable to complete bithermal caloric testing. Results of cool irrigations reveal probable left ear unilateral weakness. Rotary chair testing normal, which suggests centrally compensated weakness.

Central occulomotor tests are normal today.

Any clarification or guidelines or cheat sheet would be greatly appreciate.

Thanks
MFournier

 

[CBLENNIE]

There is a CPT code for monothermal caloric testing, 92538-Caloric vestibular test with recording, bilateral; monothermal (i.e., one irrigation in each ear for a total of two irrigations).

I would say it is appropriate to bill for 92538 and if it was done in the office using the practices equipment you would bill for the global procedure, so no modifier 26.

 

[mfournier]

Hello:
Thanks for the response.
This is only for reading so I've instructed the 26 mod is to be used.
What about the 52 modifier.

I'm still not sure where these irrigations are listed and whether is one,two and so on.

Can you clarify it this on the note I have listed?

Thanks so much

 

[CBLENNIE]

What is listed is that the right ear was done, and the left ear was done but the documentation piece meal,

Calorics:: Abnormal (cool only 37% right stronger, total of 35deg/sec)

The above shows the specific results for the right ear, so you can see that one irrigation was done here.

Patient unable to complete bithermal caloric testing. Results of cool irrigations reveal probable left ear unilateral weakness.

The above statement makes it clear that the left ear was done as well by indicating "probable left ear unilateral weakness", so here is one more irrigation.

So your documentation does support that 92538-Caloric vestibular test with recording, bilateral; monothermal (i.e., one irrigation in each ear for a total of two irrigations) was performed because only one temperature was done, the cool, and between the 2 different statements in the note about the right and left ear caloric testing shows one irrigation was performed on each ear, so you wouldn't bill modifier 52 because the full service was provided. If you were directed to bill mod 26 with caloric vestibular tests, I can't speak to that direction.

 

[mfournier]

Ok thanks for clarifying