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Dix-Hallpike procedure

Jeffrey Sirianni audioman at HCTC.NET
Tue Jul 1 22:29:56 EST 1997

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

Jeffrey Sirianni <audioman at hctc.net>, who wrote:

>> 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?

>Ahh, we *were* talking about the Hallpike maneuver to start! I'll bet
>the CPT code poster was just confused about semantics, as I was.
>"Dix-Hallpike procedure" was an early term for calorics with
>observation. Dr. Hallpike came up with lost of useful tests...

I was talking about the maneuver used for testing BPPV.  Our system is
very old, so we don't have all the things you have there.

I perform the following:

1. Gaze Testing
2. Positional Testing
3. Hallpike Maneuver for BPPV
4. Pendular Tracking
5. Optokinetic Testing
6. Bithermal, Binaural Caloric Irrigations
7. Vertical Leads

I bill for all of the above, except for the Hallpike Manuever which there
is no CPT code.  In addition, Medicare no longer pays for gaze testing.

>Yes, we do the Hallpike maneuver and don't charge specifically for it.
>It's part of a whole host of subtests that we do do as part of an ENG
>battery which don't have CPT codes, like saccade (the 92546 code is for
>pursuit only), Fukuda stepping, ocsillopsia, and postural control tests
>like Romberg and CTSIB. The trick is to set you charges for what you
>*can* bill for high enough to cover all the subtests you need to do in
>order to provide adequate diagnostic information. 

That answers my question.  You do the test, analyze it, report on it, but do
not get paid for it.  Thank you for clearing up this question.

>It just demonstrates that CPT coding is a mess. We can't wait around for
>a CPT code to come out before doing appropriate tests and procedures. It
>took 12 years to get a code # for Dynamic Posturography, and most
>insurers don't accept it anyway. The CPT code used for rotary chair is
>actually a code for "Torsion Swing" test, which you can't even buy
>anymore. The code assigned to rotary chair was *never* accepted by
>insurers, so labs went back to using the old torsion swing code in order
>to get paid. There is no CPT or ICD-9 code for vestibular rehab either,
>you just have to dig through the book until you find one that seems to
>fit that you can get paid for in your area. Onward and upward...

You would think that clinicians with basic equipment, like myself, and
that the Hallpike Manuever for BPPV has been around so long, that a CPT
code would be around for billing of this test.  With my equipment, I have
no other way for testing for BPPV.

Thanks for your comments....

Oh, I thought that a new CPT code was available for Vestibular Rehab.  I
thought I heard that at AAA this year.

* Jeff Sirianni, M.A., CCC-A                      *
* Sound Advice / R.G. Delaney, M.D.               *
* 710 Water Street / Suite 404                    *
* Kerrville, TX  78028                            *
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* audioman at hctc.net                               *
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* Discussion Leader of bionet.audiology Newsgroup *

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