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Vestibular Testing - Are You Dizzy Yet?

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Welcome to Healthcare Fraud Shield's "The Buzz". This week's article looks at "Vestibular Testing-Are You Dizzy Yet?" Check out the article below or on the Healthcare Fraud Shield blog where you can access our previous articles.

Sincerely,

 

Healthcare Fraud Shield

Vestibular Testing - Are You Dizzy Yet?

  

What is Vestibular Testing?

Vestibular testing consists of a variety of procedures related to the vestibular organs, or the inner ear. The inner ear is not only responsible for hearing, but also for balance.   Vestibular tests are used to discover the reasons behind any issues related to the inner ear, in particular involving patients with symptoms such as dizziness.   According to the American Hearing Research Foundation, if dizziness is not the result of problems with the inner ear then, it could be due to other issues related to the brain. [1] Therefore, performing vestibular testing is a way to identify and/or rule out the cause of the problem.

What are the specific tests performed?

There are several types of Vestibular Tests that may be performed including, but not limited to:

  • Electronystagmography (ENG)
  • Electrocochleography (ECOG)
  • Rotational chair test
  • Posturography
  • Fistula test

Many of the tests are recording eye movements also referred to as nystagmus.   Refer to the American Hearing Research Foundation for a detailed description of the equipment used for each of the above-mentioned tests. [2]

Is it a Covered Service?

The policies vary from plan to plan.   Many insurance carriers only cover some of the Vestibular Tests listed in the CPT® book. For example, BlueCross BlueShield of North Carolina considers Dynamic Posturography (CPT® 92548), which is just one of the Vestibular Tests, experimental and not a covered service. [3] UnitedHealthcare covers most of the services (with the exception of CPT® 92548) as long as there is a diagnosis related to hearing or balance. [4]

How is it Billed?

The Vestibular Function Test procedure codes are located in the medicine section of the CPT® book. Codes 92531-92534 are for Vestibular Function Tests without electrical recording and codes 92540-92548 are for are for Vestibular Function Tests with electrical recording. Pay close attention to the CPT® descriptions as many of them contain parenthetical notes indicating some of these codes cannot be billed together. For example, 92540 is not to be reported at the same time as 92541, 92542, 92544, or 92545. In addition, 92547 is an add-on code which may be billed along with 92540-92546. However, ensure the number of units billed for 92547 matches the number of vestibular tests performed.

How do I look for suspect billing?

As investigators you should use your data mining software tools such as PostShield or internal querying systems to look for any unbundling based on the AMA's guidelines, any inappropriate or excessive billing of the add-on code 92547, and any providers that appear to be outliers compared to their peers.  

If you have any questions or need any assistance data mining for vestibular function testing, feel free to contact us at info@hcfraudshield.com.

REFERENCES:

[3] BSBCNC
[4] UHC
 
   
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