The Correct Coding Initiative (CCI) came down hard on practitioners who perform vestibular testing earlier this year, but a new correction, effective Oct. 1, should ease the restrictions and help the otolaryngology, neurology, and audiology practices that report these services.
The problem: CCI edits currently restrict practices from reporting 92541, 92542, 92544, and 92545 individually if three or less of the tests are performed, notes Debbie Abel, Au.D., director of reimbursement and practice compliance with the American Academy of Audiology.
The solution: Starting October 1, 2010, “if two or three of these codes are reported for the same date of service by the same provider for the same beneficiary, an NCCI-associated modifier may be utilized to bypass the NCCI edits,” CMS wrote in a decision to alter the edits.
The American Speech-Language-Hearing Association (ASHA) has requested “clarification regarding the correct NCCI-modifier to use when reporting the codes to Medicare,” noted Lemmietta G. McNeilly, PhD, CCC-SLP, CAE, chief staff officer of Speech-Language Pathology with ASHA, in a July 29 announcement.
Look for Changes to Vestibular Testing Descriptors
The root of the CCI problem began when the 2010 CPT manual was published, including new code 92540 (Basic vestibular evaluation …) and the subsequent codes following it, which make up the individual components of 92540. “The clarification that resulted in the NCCI edits being lifted should be included in upcoming versions of the manual,” Abel tells Part B Insider.
According to the AMA’s Errata page, code descriptors should read as follows, effective Oct. 1:
- 92540 — Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording (Do not report 92540 in conjunction with 92541, 92542, 92544, or 92545)
- 92541 — Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording (Do not report 92541 in conjunction with 92540 or the set of 92542, 92544, and 92545)
- 92542 — Positional nystagmus test, minimum of 4 positions, with recording (Do not report 92542 in conjunction with 92540 or the set of 92541, 92544, and 92545)
- 92544 — Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording (Do not report 92544 in conjunction with 92540 or the set of 92541, 92542, and 92545)
- 92545 — Oscillating tracking test, with recording (Do not report 92545 in conjunction with 92540 or the set of 92541, 92542, and 92544).