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Dix-Hallpike procedure

Tom Boismier boismier at umich.edu
Fri Jun 27 09:15:50 EST 1997

Jeffrey Sirianni wrote:
> Ok, so if I perform four caloric irrigations and record them, I bill as
> a 92543.  If I also perform the Dix-Hallpike, then I cannot bill for a
> 92543 again, or can a bill for 92543 twice?

Quotes from the AMA's CPT '97 handbook:
(under the category) "Vestibular Function Tests, With Observation and
Evaluation by Physician, Without Electrical Recording"

"92533   Caloric vestibular test, each irrigation (binaural, bithermal
stimulation constitutes four tests)"
(under the category) "Vestibular Function Tests, With Recording (eg ENG,
PENG), and Medical Diagnostic Evaluation"

"925453   Caloric vestibular test, each irrigation (binaural, bithermal
stimulation constitutes four tests), with recording"
In practice many insurers, including all the one's we deal with in
Michigan interprete this as 'one price no matter how many irrigations
you do' (don't ask me how they come to this conclusion...).

> Please clarify your answer.  Also, I'm not the only person alive who
> performs four irrigations plus the Dix-Hallpike procedure.  Please
> speak up and be heard.

I'm curious, why do both? It seems like doing an ABR to investigate
possible CPA mass lesion AFTER getting contrast CT of the temporal
bones. If you've already done the gold standard test, why do the
screening test? 

I missed the beginning of this thread, so maybe I'm just confused. Are
you referring to doing calorics with recording, and calorics *again*
with visual observation? Or are you referring to the Hallpike maneuver
for BPPV (which there is no CPT code for).

Thomas E. Boismier, MPH <boismier at nospam.umich.edu>
Associate Director, Vestibular Testing Center
Department of Otorhinolaryngology
University of Michigan Hospitals

[Remove "nospam." from the above address to email me]

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