Disclaimer: The information provided here is as a courtesy and is not intended to be used without first consulting a credentialed billing and coding expert for your area.
Posted 10-13-2010
National Correct Coding Initiative edits lifted on 10/1/10 for single vestibular CPT codes
As previously announced, effective October 1, 2010, CPT codes 92541, 92542, 92544, and 92545 are now allowed to be filed separately, if only one, two or three of these procedures are performed on the same date of service, by the same provider, for the same beneficiary. An NCCI-associated modifier –59, distinct procedural service, is to be appended when filing these codes separately. (Note that no retroactive billing with these NCCI changes for these separate codes is permitted).
If all four codes are performed at the same time, CPT code 92540, the basic vestibular evaluation bundled code, must be utilized for reimbursement by Medicare and the majority of commercial payors. Click here for more information.
Contributed by:
Debbie Abel, Au.D.
Board Certified in Audiology
Director of Reimbursement and Practice Compliance
American Academy of Audiology
1.800.222.2336
www.audiology.org
www.howsyourhearing.org is a NEW consumer web site
Disclaimer: The purpose of the information provided above by the American Academy of Audiology Coding and Reimbursement Committee is to provide general information and educational guidance to audiologists. Action taken with respect to the information provided is an individual choice. The American Academy of Audiology hereby disclaims any responsibility for the consequences of any action(s) taken by any individual(s) as a result of using the information provided, and reader agrees not to take action against, or seek to hold, or hold liable, the American Academy of Audiology for the reader's use of the information provided. As used herein, the "American Academy of Audiology" shall be defined to include its directors, officers, employees, volunteers, members and agents. www.audiologyNOW.org
Subject: 2010 VNG billing and coding status, including 92540
From: Daniel B. Scherer, Managing Director and
Dr. Randolph McKenzie, Medical Director
RECENT NEWS:
Please review this PDF from the American Academy of Audiology. Effective October 1, 2010, payment restrictions are lifted on the single vestibular codes (92540-92541-92542* - 92544-92545).
Thanks are to be extended to the American Academy of Audiology, the American Speech-Language-Hearing Association, the American Academy of Otolaryngology-Head and Neck Surgery and the American Academy of Neurology for their combined efforts to accomplish this.
We will be sending more information pertaining to the referenced “modifier” needed as soon as it becomes available. To be added to our distribution list, please contact us.
RECENT NEWS:
The latest information was compiled on 02-18-2010 by Dr. Randolph McKenzie, Medical Director of the Better Balance Fall Prevention and Wellness Society, LLC. Dr. McKenzie states,
"Action has been taken against the attempt to bundle CPT 92541-42-44-45 under CPT 92540; thereby severely reducing the reimbursement for VNG testing. This action has been taken jointly by the AAOHNSF, the American Speech & Hearing Association (ASHA), the American Academy of Audiology (AAA) & the American Academy of Neurology (AAN) by way of an official protest sent directly to CMS to inact a change in the reimbursement policy on these codes to reinstate the previous reimbursement, thereby rectifying the impact this change has made. A response from CMS is expected in 30 days. Efforts are being made at the highest levels of each of these professional organizations collectively representing thousands of health care professionals involved in the diagnosis and treatment of patients with balance disorders. This is indeed promising news that these elite organizations are working together to overcome this latest challenge and all hope points to a positive result."
The Better Balance Fall Prevention and Wellness Society, LLC will keep you informed to any further updates as quickly as they become available. We continue to work hard and diligently on providing everyone the very latest information on all topics pertaining to balance medicine.
2010 VNG billing and coding status, including 92540
Date posted: February 17, 2010
As many already are aware, effective January 1, 2010 a new code was introduced as 92540. This code now incorporates codes 92541, 92542, 92544 and 92545. Not surprisingly, the “new” 92540 codes reimbursement is lower than all of the combined, individual codes. The percentage of decrease varies throughout the country, but averages close to 30%.
Equally not surprising is the tremendous confusion this “new” code has created. Daily we hear from many of you about what is going on in your state, either through direct experience or by hearsay.
We are feverishly working to untangle the confusion and the purpose of this communication is to attempt to shed some light on what is happening and provide suggestions on solutions. While we do not have all the answers, we will. However, we have been able to develop a clearer picture of what is going on, where things are worse and steps that need taken to help.
At the forefront of this confusion is the ambiguous nature of the CPT language. Many states experience no changes in reimbursement while a few other states have reported rejected or automatically bundled claims. It appears Medicare intermediaries are interpreting the use of the new code very differently in some parts of the country.
Adding to the confusion, in a January, 2010 HCPCS Special Bulletin distributed by the Texas Medicaid and Healthcare Partnership (click here for PDF) the 92540 code is listed but with an asterisk defined as, “Proposed benefit pending approval of expenditures”.
So one must ask, is this code in effect or not?
The bundled code, 92540 is defined in the 2010 CPT Guide – Professional Edition as follows, “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.”
“This new code includes four component codes: 92541 (spontaneous nystagmus), 92542 (positional nystagmus), 92544 (optokinetic nystagmus), and 92545 (oscillating tracking). Do not report 92540 with any of the component codes”.
What we know:
1. The 2010 CPT Guide – Professional Edition lists the new code and its uses on page 451 (click here for PDF).
2. The HCPCS special Bulletin lists the code but shows it “pending”. (Click here for PDF)
3. Georgia, Arizona and California have reported either reduced reimbursements or rejected claims, while all other areas have not yet experienced changes or at least not reported any.
What can be done? – Fine tune your coding procedures:
1. If your claims are being paid under the separate codes, we suggest you continue to bill them until you experience changes. In some regions, because the 92540 code is still under review, claims are being paid while in the review process. At some time in the future, the review process will conclude and then perhaps more clarity will become available on this issue.
2. If you have begun to experience reductions or even if you have not, you should still fine-tune your coding. Following are some suggestions where applicable:
a. Bill the bundled code as listed, but be sure to bill the proper number of units on the other, unbundled codes, which include:
i. 92543 – Calorics Vestibular Testing – 4 units
ii. 92546 – Sinusoidal Vertical Axis Rotational Test – 2 units
iii. 92547 – Vertical Recording – 5 units
b. Check with your billing and coding person to make certain you are not under-coding your Evaluation & Management codes. Statistics support many physicians incorrectly under-code E & M’s. Make sure you review this critical area. Refer to the E&M coding table for assistance (click here for PDF).
c. It is appropriate to re-test a patient following VRT or treatment on just the phases of the VNG test that patient tested “abnormal” in. Please refer to CMS LCD-L29555, revised 1-15-2010 (click here for Word document) that states;
“Re-evaluation is appropriate at a schedule dictated by the ordering physician when the information provided by the diagnostic test is required to determine changes in hearing, to evaluate the appropriate medical or surgical treatment or to evaluate the results of treatment.”
d. If not trained in Canalith repositioning, receive training to perform the various repositioning protocols for the proper treatment of BPPV. This is billed under code 95992 – Canalith Repositioning(s) (e.g. Epley maneuver, Semont maneuver) per day. To learn the proper ways to perform these repositioning maneuvers, please attend one of our Better Balance CME courses. The subject is covered and demonstrated.
e. Another consideration is adding an Audiometric evaluation to your patient evaluation protocol. This test is in addition to the evaluation platform to aid in properly assessing the patient’s vestibular system by providing solid evidence of medical necessity. These tests can be conducted by an Audiologist, by prescription from the physician, or the prescribing physician may conduct the test themselves. The test also may be performed by a trained technician under the “direct” supervision of the physician. Again, refer to the CMS LCD-L29555 for guidelines. Simple handheld devices to conduct these tests are very reasonably priced. This would be billed under codes 92551 – Screening, Pure-tone air only and 92552 – Pure-tone Audiometry (threshold) air only.
f. Whether you have experienced problems with the 92540 code or not, you should seriously consider implementing a VRT (Vestibular Rehab Therapy) protocol into your practice. First and foremost it offers your patients tremendous positive outcomes. Secondly, it reimburses very well (far superior to VNG testing) and third it can easily integrate into your practice. Dr. McKenzie will help instruct you and your staff on proper VRT protocols and what is needed to be successful with VRT in your practice.
What we’ve heard is being done, but is not endorsed or recommended by us.
1. Instructing the patient to come in on sequential days to perform different portions of the test so each separate code may then billed. Of course this makes little sense and is not in the best interest of the patient.
2. Billing just three of the four codes made up in the bundled code. If you refer to the 2010 CPT Guide – Professional Edition, page 451 (click here for PDF), it states each of the four codes is not to be used in conjunction with the other codes, thereby eliminating doing this type of billing.
There is no magical fix to 92540. There is a lot of confusion, but this is a great time to hone and fine-tune what we are doing and how we do it. By implementing some of the items discussed herein, the negative effect of the coding change can be greatly lessened. If in the coming months the review process rules in favor of retaining separate codes, then you will be even more efficient and properly reimbursed.
We assure you that we will continue to monitor and be proactive in reporting conditions revolving around all vestibular testing and VRT, whether it be billing and coding, new or refined protocols, new or changing technology, legislative efforts and anything else affecting balance medicine.
Please share with us any experiences or thoughts you have, regarding not just billing and coding, but any successes or challenges you face. We would appreciate your feedback so we are able to pass along information for others to learn as well. Dr. McKenzie and I can be reached at 260-436-1432 or by e-mail DanielScherer@comcast.net or to Dr. McKenzie at balancedoc1@yahoo.com.
We look forward to hearing from you.
Best Regards,
Daniel B. Scherer Dr. Randolph McKenzie
Managing Director Medical Director
PS: Be sure to visit www.betterbalancefallprevention.com/cme_seminars.html for updates and locations of our Better Balance CME courses.
Disclaimer: The information provided here is as a courtesy and is not intended to be used without first consulting a credentialed billing and coding expert for your area.
