Every so often, I run across something that I feel the need to make public. Anyone who does vestibular testing knows there have been many recent changes in reimbursement for these tests. Many specialists can no longer afford to see “dizzy” patients. Not all these changes are the result of Medicare’s reaction to fraudulent billing, but some of them are.
A couple of weeks ago at an American Medical Association meeting in Los Angeles, I had the opportunity to sit down with representatives from the Academy of Otolaryngology, the Academy of Neurology, and ASHA to discuss vestibular coding and reimbursement. One of the topics discussed was the high percentage of vestibular test codes that are billed incorrectly, and possible solutions to the problem. Proceedings at the AMA are confidential, so I can’t share details of the discussions, but there was one point made that I think is worth repeating and does not break confidentiality to share.
Someone asked why there was so much incorrect billing despite the fact that these issues have been addressed and clear statements regarding correct billing have been published in the AMA CPT Assistant newsletter. If your response to this is “What’s the CPT Assistant newsletter?” you have partly answered the question. The CPT Assistant is a subscription publication, sold by the AMA, at a cost of $250. Basically, this is expensive and you have to go looking for the information, so not too many people see it.
On the other hand, if someone sends you a FAX, or knocks on your door, and tells you that you can earn a lot of money by adding vestibular testing to your practice, and tells you that you can bill certain codes for doing so, you are more likely to pay attention. Bottom line, there is a lot more misinformation out there than there is correct coding information.
Just to be clear, despite what some salesman may tell you, Medicare guidelines state that you CANNOT bill 92270 (Electro-oculography) as part of the ENG/VNG battery, and you CANNOT bill 92546 (Sinusoidal Vertical Axis Rotation) for VAT/Vorteq testing in most states.
Below, you will find a statement from the American Academy of Otolaryngology-Head and Neck Surgery regarding CPT code 92270 (This also applies to all physicians and audiologists). I have discussed the abuse regarding CPT code 92546 previously on this blog.
Q: Can Otolaryngologists Report the CPT Code 92270 (Electro-oculography with interpretation and report) to indicate Saccadic Testing during an Electronystamography (ENG) Procedure?
A: It has come to the Academy’s attention that otolaryngologists are reporting CPT code 92270 Electro-oculography with interpretation and report to describe saccadic testing during an ENG procedure. To follow the American Medical Association’s Current Procedural Terminology (CPT®) guidelines, providers should only use this code to document a standard test of the electrical potential created in a retina when exposed to light for Best Vitelliform Maculopathy.
As a result, otolaryngologists and their practices should not report CPT code 92270 with ENG testing (CPT codes 92541-92547, Vestibular Functions Tests, With Recording).
Where do people get the misinformation? Most likely from equipment salespeople convincing doctors that they can make a fortune opening a vestibular testing mill in their office. Here is one example from a company called SeniorFalling.com. If you attempted to bill the vast majority of Medicare carriers using the example given on their home page, you might find yourself in a lot of trouble. I’m just saying!
