Neurology & Pain Management Coding Alert

Question: Our carrier will only reimburse for visual evoked response testing if I code optic neuritis and not, for instance, for multiple sclerosis (MS). Is this correct?

Maryland Subscriber

Answer: Visual evoked potential (VEP) testing (95930, central nervous system, checkerboard or flash), also known as visual evoked response tests (VER), evaluates the integrity of visual nerve pathways (retina and optic nerves) by measuring the brain's response to repetitive visual stimuli. Electrodes are placed on the patient's scalp at the occiput and parietal locations. A reference electrode is placed on the ear. One eye is occluded (blocked) and the patient is asked to focus on a dot in the center of the screen. A checkerboard or, in some cases, a flash pattern is projected and reversed 100 times at a rate of once or twice per second. The procedure is repeated for the second eye. Visual neural impulses are recorded as they travel from the eye to the occipital cortex. A computer examines the data and plots the results.
 
Individual carriers may determine which diagnoses support medical necessity for such testing, and a review of local medical review policies (LMRPs) reveals a fairly broad range, including MS (340, multiple sclerosis). In addition to MS, a partial list of acceptable diagnoses listed in Blue Cross/Blue Shield of North Dakota's (BCBSND) LMRP for Colorado, North Dakota, South Dakota and Wyoming (Policy # 96.21B) includes:
 

300.11 conversion disorder

368.0-368.9 amblyopia ex anopsia

386.0-386.9 Mnire's disease

431-435.9 hemorrhage, etc.

768.0-768.9 intrauterine hypoxia and birth asphyxia

850.4-853.1 concussion

907.1-907.5 late effects

952.00-957.9 spinal cord injury.
 
If your carrier does not accept diagnosis 340, contact them to receive a list of specifically allowable diagnoses for VEP testing.
 
Other guidelines apply for VEP testing. For instance, BCBSND LMRP # 96.21B specifies VEP testing "is covered only when standard methods (i.e., nerve conduction velocities) are not effective for the individual patient." According to the policy, usual indications for testing are to:

 

Diagnose the presence of lesions in the auditory system external to the brain stem

 

Evaluate brain stem function in acquired meta-
bolic disorders

 

Measure nerve conduction when not accessible or measurable by standard techniques

 

Document axonal continuity when sensory nerve conduction studies are not obtainable (i.e., nerve injury)

 

Assist in the diagnosis and management of demyelinating or degenerative diseases of the brain stem

 

Determine whether sensory symptoms have a nonorganic basis (e.g., conversion reaction)