Last week, I took a fast trip to the west coast to attend a meeting of the American Medical Association. We finally settled on a new set of codes for performing caloric irrigation with recording. While standard practice is to perform four total irrigations, there are times when the clinician may decide to perform just two irrigations.
The performance of four irrigations is referred to as bithermal (two temperatures), bilateral (both ears). Performing only two irrigations is referred to as monothermal (one temperature), bilateral (both ears).
The code for caloric irrigation has been a source of frustration for years now. To begin with, it was the one code in the standard VNG battery that was not bundled into the “Basic Vestibular Evaluation” code (92540) in 2010. When codes are billed together frequently, Medicare will eventually force them to be combined in to one code at a much lower value. Calorics escaped the bundling in 2010 because it was not billed together as often with the other VNG codes. I believe this was the result of two factors: 1. If a patient is diagnosed with BPPV, they may not need caloric irrigation testing, and, 2. There was a business going around selling “non-caloric ENG” packages to primary care offices.
When the other codes in the VNG battery were bundled, they were surveyed and valued, receiving some reimbursement for the cost of the person performing the test. Inadvertently, or at least incorrectly, the reimbursement for the time and salary of the person performing the caloric irrigation test was omitted, causing the gradual drop in reimbursement you may have noticed starting a few years ago.
Although Medicare was made aware of this error in 2009, it took five years to bring the code back to the table for survey. The initial survey was a mess. The instructions asked the survey participants to rate the time and difficulty of performing one irrigation. Unfortunately, the majority of respondents filled out the survey based on the time of performing all four irrigations. The data was rejected by the AMA, an interim value for the code recommended by the AMA was rejected by Medicare, and we were sent back to the drawing board.
For a number of reasons, some too mundane to review here, we decided to propose two new codes to replace the one old caloric code. In the past, the caloric code was considered a multi-unit code, meaning that it could be billed more than once on the same day. If you did two irrigations you billed 92543 times 2. If you did four irrigations, you would bill 92543 times 4.
The two new codes are to be billed just once a day, indicating whether you did two or four irrigations. The CPT code number and values will be released later in the year and will be in effect in 2016.