Audiologists began reporting a new "bundled" Current Procedural Terminology code (CPT, © American Medical Association) for a basic vestibular evaluation on Jan. 1, 2010. An error in the CPT codebook soon created confusion and billing problems for both audiologists and Medicare. Extensive advocacy by ASHA and other groups (American Academy of Otolaryngology–Head and Neck Surgery, American Academy of Audiology, American Academy of Neurology) subsequently resolved the error. The following questions and answers should help clarify billing and reimbursement for vestibular codes.
Q: What is the bundled vestibular code?
The bundled vestibular code that took effect in 2010 incorporates well-known vestibular procedures usually billed in combination with one another as a basic evaluation. The CPT code is:
- 92540—Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording (92541); positional nystagmus test, minimum of 4 positions, with recording (92542); optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording (92544); and oscillating tracking test, with recording (92545).
The 92540 code should be billed when all four procedures are performed on the same day, and may not be billed in conjunction with any of the four individual codes it embraces.
Q: Why did audiologists see problems billing vestibular test codes in 2010?
The 2010 CPT codebook included an error—parentheticals for each of the four individual vestibular codes indicated that they could not be reported in conjunction with any of the other three vestibular codes. For example:
- 92541—Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording. (Do not report 92541 in conjunction with 92542, 92544, and 92545.)
Based on the 2010 CPT codebook, the Centers for Medicare and Medicaid Services (CMS) National Correct Coding Initiative (NCCI) established edits that prevented audiologists from billing Medicare for any combination of two or three of the individual vestibular test codes. These edits left audiologists with only two options: performing all four procedures (92541, 92542, 92544, and 92545) or billing for only one vestibular test.
Q: Has the error been corrected?
Yes. ASHA and the other organizations actively lobbied CMS to correct these edits but CMS would not revise its policy until the American Medical Association (AMA) made a correction to the parenthetical limitations in the CPT codebook. On July 22, 2010, the AMA published a correction on the CPT errata webpage [PDF]. An example of a corrected parenthetical follows:
- 92541—Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording. (Do not report 92541 in conjunction with 92540 or the set of 92542, 92544, and 92545.)
The NCCI edits were subsequently corrected and became effective Oct. 1, 2010.
Q: How should the vestibular test codes now be billed? Do I need to use a modifier?
According to current CMS policy, audiologists and physicians may bill for 92540 (basic vestibular evaluation), for any one of the vestibular test codes, or for any combination of two or three of codes 92541 (spontaneous nystagmus), 92542 (positional nystagmus), 92544 (optokinetic nystagmus), and 92545 (oscillating tracking).
When the same provider bills for two or three of these vestibular test codes on the same day for the same beneficiary, audiologists should use modifier -59 to indicate that each code is a "distinct procedural service." CPT 92540 must be used when billing for all four of the vestibular tests.
For instructions on the use of the -59 modifier and the list of NCCI edit pairs, visit ASHA's reimbursment webpage.
Q: Are there other bundled codes for audiology?
Yes. Two other bundled codes became effective Jan. 1, 2010:
- 92550—Tympanometry (92567) and reflex threshold measurements (92568). (Do not report 92550 in conjunction with 92567 or 92568.)
- 92570—Acoustic immittance testing, includes tympanometry (92567), acoustic reflex threshold testing (92568), and acoustic reflex decay testing. (Do not report 92570 in conjunction with 92567 or 92568.)
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