Billing/Coding

Billing Codes: VNG  (Videonystagmography)

92540              1 Unit

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.

NOTE: This code includes four component codes: 92541 (spontaneous nystagmus), 92542 (positional nystagmus), 92544 (optokinetic nystagmus), and 92545 (oscillating tracking).

Do not report 92540 with any of the component codes.

 92541 Refer to 92540

(1 unit with modifier after 10-1-10)

Spontaneous nystagmus test including gaze and fixation nystagmus, with recording. These nystagmus tests document and measure the inability of the eyes to maintain a static position as a result of peripheral, CNS (Central Nervous System) or congenital abnormality. The tests are conducted with the eyes open and closed and in “eyes forward” as well as “eyes right” and “eyes left” positions.

92542        Refer to 92540

(1 unit with modifier after 10-1-10)

Videonystagmography VNG Demonstration

Positional nystagmus test, minimum of four positions, with recording. These spontaneous nystagmus tests document and measure the inability of the eyes to maintain a static position when the head is in different positions. These tests are valuable in documenting and quantifying patient complaints of dizziness in certain situations or positions. They are sometimes helpful in localizing the abnormality as CNS or peripheral. 

92543 (inactive)       NOW 92537 - 1 Unit

EFFECTIVE 1-1-16

Caloric vestibular test, each irrigation (binaural bithermal stimulation constitutes four tests), with recording. The caloric tests evaluate the viability of the peripheral end organs by stimulating them with warm and cold water or air while the patient is in the dark. The resulting dizziness and nystagmus is taken as an index of the viability of the organ. This helps in evaluating the ability of the CNS to visually suppress inappropriate dizziness and nystagmus.

92544 Refer to 92540

(1 unit with modifier after 10-1-10)

Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording. The optokinetic test documents and measures eye movements as the patients watches a series of targets moving simultaneously to the right and then to the left. The optokinetic mechanism is at work when the visual movement in one direction encompasses more than a single point.

92545      Refer to 92540

(2 units with modifier after 10-1-10)

Oscillating tracking test, with recording.  The smooth pursuit test evaluates the ability of the patient to keep a moving visual target registered on the fovea. The patient watches a moving target as it moves back and forth in a smooth pendular fashion. The saccadic test evaluates the ability of the patient to find a moving target and tests certain CNS neural integrators. The computer computes the gain (target velocity divided by eye velocity) and compares the gain to age matched norms.

92546              2 Units

Sinusoidal vertical axis rotational testing.  This is a computerized test of the Vestibulo-Ocular Reflex (VOR), the neural mechanism that keeps a visual image registered on the fovea during head movement. It evaluates the three functional components of the VOR system: the peripheral end organ, the vestibular nuclei of the brain stem and the higher central vestibular connections. The test is accomplished by having the patient (with goggles on) move their head in both the horizontal and vertical plane at increasing velocities while the VOR system measures head velocity.  From this data, the computer computes three characteristics of the VOR: gain (ratio of eye velocity to head velocity, phase (the number of degrees by which the eye “misses” the target), and asymmetry (a comparison of gain moving right with gain moving left).  This information is useful for evaluating patients with balance disorders.  Refer to article titled, “VAT Explanation & Justification.”

92547              1 Unit

Vertical Recording