Oculomotor Tests

s pursuit

Cpt Code 92544 and CPT Code 92545

This week we wrap up our descriptions of the components of the Videonystagmography examination with the oculomotor tests.* Since the preparation and procedures are so similar, I will cover both optokinetic tracking and smooth pursuit (oscillating) tracking in the same blog, but will delete repetitive sections.

CPT Code 92544 – Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording – It is common to have patients refrain from medications used to treat dizziness, nausea, pain, anxiety or depression prior to vestibular testing as they can falsely suppress vestibular responses. Before testing, the examiner must question the patient regarding any medications that may affect test results. The patient must also be questioned regarding current symptoms, as vestibular disorders are not static, but rather typically occur episodically. The patient must also be questioned about visual status, prior history of known eye mobility issues, and a quick visual scan of eye range of movements and symmetry.

The patient is instructed to sit quietly during this test. Goggles with cameras illuminated by infra-red lighting are placed on the patient. The darkest spot of the eye, the pupil, is tracked by the software, so a tracking threshold must be established. Once tracking is established, a calibration procedure begins where the patient is asked to visually track a moving target that travels over fixed parameters (or degrees), in order to quantify eye movements.

The patient is instructed to visually follow a series of lights or stripes moving repetitively across an LED light bar or projected on a blank wall. This is performed in both directions, right to left then vice versa, and is often repeated for increased reliability. Recorded eye movements are analyzed for symmetry and gain, with artifactual eye movements removed. With the assistance of sensitive computer software algorithms, a determination of age-weighted normal versus abnormal optokinetic tracking is made.

CPT Code 92545 – Oscillating tracking test, with recording (Smooth Pursuit): The patient is instructed to visually follow a light moving predictably in a horizontal and or vertical pendular fashion across an LED light bar or projected on a blank wall. This is performed at multiple speeds. Recorded eye movements are analyzed for symmetry and gain, with artifactual eye movements removed. With the assistance of sensitive computer software algorithms, a determination of age-weighted normal versus abnormal smooth pursuit tracking is made.

* There is no CPT Code for Saccadic tracking.

Photo courtesy of www.dizziness-and-balance.com

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.