Question
Our hospital audit committee has received a statement from the AMA stating that the PT code 92547 may not be used for vertical recordings when VNG (goggles) are utilized instead of electrodes. We have been instructed to use CPT code 92700 Unlisted otorhinololaryngological procedure. Is this true? Thank you.
Answer
The use of a code implies a specific action that takes place during a provider/patient contact. In this case, the code justification and description are based on the application of additional electrodes in the vertical plane and either an upgrade in the cost of the equipment for the simultaneous horizontal plus vertical recording or (more often) the additional time associated with changing the electrode array for recording and re-stimulating to determine whether a vertical component to the nystagmus exists. The majority of the value of reimbursement is based on the time we spend with a patient. That is because audiologists are considered ''practice expense'' rather than ''physician work''. Practice expense is determined by the following factors: (1) pre-service, intra-service, and post-service contact time and activities, (2) capital equipment expenditures and depreciation, and (3) disposable supplies. For the intra-service time, there is a specific description of activities to justify, minute by minute, the length of time requested for valuation. It is most likely because of the specificity of the activities described in the code justification that the interpretation exists that 92547 cannot be used when utilizing recording goggles rather than the vertical electrode array. Although repeated calibration is common to both set-ups, the time required for electrode application and either the repeated stimulation or the additional analysis time for the vertical electrodes has not been described for the goggles in a specific code. In order to have a ''clean'' billing arrangement for vertical nystagmous using goggles, the following would be required: (1) a significant proportion of use among diagnosticians, (2) specific support in the peer reviewed literature highlighting the usefulness of goggles for vertical nystagmous as a separate procedure and analysis from the horizontal nystagmous measurements and analysis, and (3) measurable time and value that would be substantially different from the 92543 code valuations.
Bob Fifer
Robert C. Fifer, Ph.D.
Director of Audiology and Speech-Language Pathology
Mailman Center for Child Development
P.O. Box 016820
Miami, Florida 33101
Street Address: 1601 N.W. 12th Avenue
Miami, Florida 33136
