CODING & REIMBURSEMENT

The ABCs of VEP

By Suzanne Corcoran

Here’s a look at the coding intricacies of visual evoked potential testing.

Q. What is visual evoked potential (VEP) testing, and why do physicians perform it?

A. Ophthalmologists perform the VEP test to evaluate a patient’s response to an external stimulus along the entire visual pathway, which includes retina, optic nerve, optic radiations and visual cortex. The test provides repeatable, objective and quantitative information to aid in diagnosis and disease management.

Most Medicare local coverage determinations (LCDs) contain a variety of valid diagnoses for VEP. For example, one LCD by Noridian, the Medicare Administrative Contractor (MAC) for Arizona, lists the following indications:

• Confirm diagnosis of multiple sclerosis when clinical criteria are inconclusive.

• Detect optic neuritis at an early, subclinical stage.

• Evaluate diseases of the optic nerve, such as:

- ischemic optic neuropathy;

- pseudotumor cerebri;

- toxic amblyopias;

- nutritional amblyopias;

- neoplasms compressing the anterior visual pathways;

- optic nerve injury; and

- to rule out hysterical blindness.

• Monitor the visual system during optic nerve (or related) surgery.

Q. How do payers reimburse this test?

A. CPT code 95930 describes this test when the physician uses it with either the fixed or customized testing protocols. The descriptor reads: Visual evoked potential (VEP) testing central nervous system, checkerboard or flash.

CPT 95930 is defined as “bilateral” so reimbursement is for both eyes. In 2014, the national Medicare Physician Fee Schedule allowable for 95930 is $134. In each area, local wage indices adjust Medicare allowable amounts. Other payers set their own rates, which may differ significantly from the Medicare published fee schedule.

Q. Must the physician be present while the technician performs VEP testing?

A. Published policies are not in agreement on this point; check your local LCD. The guidelines for the Arizona MAC state: With respect to CPT … 95930, the level of supervision … is defined as follows: … the technician with certification may do the test under general supervision (the physician is not immediately available), and the technician without certification may do the test only with direct supervision (the physician is immediately available).

Q. What is the frequency of VEP testing in Medicare?

A. VEP is an infrequent test and payment data is not available from most payers. Until fairly recently, the test required a special shielded room to be reliable. Medicare claims data for all of 2012 for CPT 95930 show payment was made only 6,228 times for ophthalmologists and 12,643 times for optometrists — and only 28,037 times among all medical specialties. These numbers represent a substantial increase over previous years, but are still small in the overall Medicare system.

No national limitations exist for repeated testing, although some MACs may publish local policies. In general, payers reimburse this and all diagnostic tests when medically indicated. Payers always require clear documentation of the reason for testing. Too-frequent testing may garner unwanted attention from payers.

Q. Is VEP testing bundled with other services?

A. Medicare’s National Correct Coding Initiative (NCCI) bundles 95930 with a number of head, neck, spine, nervous system and electrophysiology codes. It is not bundled with any common ophthalmic-use codes except 64612.