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Dix-Hallpike procedure

Jeffrey Sirianni audioman at HCTC.NET
Fri Jun 27 23:24:44 EST 1997

Tom Boismier <boismier at umich.edu> replies to:

Jeffrey Sirianni <audioman at hctc.net>, who 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? 

Are you saying that by doing binaural, bithermal caloric testing that
also doing the Dix-Hallpike Manuever is unnecessary?

>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).

The original post implied that the Dix-Hallpike procedure was catagorized
in the CPT realm as a caloric test (which it is not).  So I asked if one
can bill the caloric CPT code twice, one for binaural, bithermal irrigation
with recording AND again for performing thr Dix-Hallpike Manuever.  You say 
that there is no CPT code for the Dix-Hallpike Manuever, so how does one
bill for it, or is it a test you do and eat the charge?

* Jeff Sirianni, M.A., CCC-A                      *
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