Pitfalls of Adding Vestibular Services -Part I

Last week I proposed that dispensing audiologists should consider adding vestibular services to their practice. I have to say, I thought it was a pretty convincing argument.  And I still think that overall, there is great benefit to all involved, and I have been encouraging audiologists regarding this for years. The problem is, in the second to last paragraph of last week’s post I mentioned that Medicare currently pays approximately $200 for a standard ENG/VNG battery. Why is that a problem?  Because it is $100 less than they paid for the same battery two years ago.  And two years from now, it will be even lower.  It is very difficult to make an investment in training and equipment when Medicare can decide to drastically reduce payment, seemingly at their whim.

Why do I say “seemingly?” There are reasons behind these reductions. The reasons are varied and variably defensible, but it is worth taking a look.  In order to understand the thinking behind these reductions, it is first necessary to understand how CPT (Current Procedural Terminology) codes are constructed.  Each code is broken down into multiple components.  One component is time.  Each procedure is broken down into pre, intra, and post time.  Pre time refers to the time it takes to prepare the patient to be seen, such as greeting them in the waiting room, walking them to the exam room, getting them seated and reviewing records.  For most audiology procedures this is fairly quick and is typically assigned about 3 minutes. The intra test time refers to the actual amount of time the procedure takes, which varies widely. Finally, the post time refers to time spent documenting results, talking with patient or family and written or verbal reporting to the referring physician.

A second component is value.  Each code is again broken down in to three components: Physician Work, approx 52%,  Practice Expense, approx 44%, and Professional Liability Insurance, approx 4%.  Work involves a combination of the time and complexity of the service (mental effort, knowledge, judgment, skill,  stress, and potential risk). Practice Expense includes resources used, such as staff, rent, supplies, etc. Professional liability is derived from actual regional malpractice premium data.

Both of these methodologies have come in to play as part of the devaluation process concerning vestibular function testing. Next week, we will get specific regarding vestibular codes affected by the American Medical Association process.


About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.