Positional Nystagmus Test

positionalsCPT Code 92542 – Positional Nystagmus Test (minimum of four positions, with recording)

Last week, I gave an example of a description used to educate physicians and health care professionals regarding several vestibular procedures. Each code is considered individually, so there is some overlap in describing patient preparation. Go to last week’s post if you want to review that portion of the description. Here is the description used for positional testing:

Prior to positional testing, the patient must be questioned regarding any back or neck issues that may put the patient at risk of injury when performing the Dix-Hallpike test, which requires taking the patient rapidly from sitting to supine with the head extended to the side and over the end of the exam table or chair. Also, the patient must undergo a short vertebral artery compression screen, during which the patient is asked to rotate their neck fully to the side, and the patient is monitored for any increase on symptoms or pathological nystagmus prior to moving them into the supine position.

Positional testing typically begins with the Dix-Hallpike test, which is performed with the head extended to one side, then repeated with the head extended to the other side. Static positional tests are typically performed in supine head center, head right and head left, and may also be performed with whole body right or left to eliminate the possible effects of neck torsion. The eyes are monitored for pathological nystagmus for 30 to 90 seconds in each position.
The examiner must make a judgment regarding physiologic endpoint nystagmus and pathological nystagmus, must delete artifact such as eye blinks from the recorded data, and measure the slow phase velocity of any pathologic nystagmus.

Photo courtesy of Tinnitus Journal

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.