Print | ShareCPT Code: 95930 Region: 02
Covered states: Connecticut, Illinois, Maine, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont, Wisconsin
Title: Visual Evoked Potential
Category
Electrodiagnostic Services
Description
Visual evoked potential testing
The visual evoked response (VER) and visual evoked potential (VEP) evaluate the visual nervous system pathways from the eyes to the occipital cortex of the brain. By measuring the function of the entire visual pathway, it helps to separate eye disease from central nervous system defects. VER/VEP involves stimulation of the retina and optic nerve with a shifting checkerboard pattern or flash method. This external visual stimulus causes measurable electrical activity in neurons within the visual pathways. The VER is recorded by electroencephalography electrodes located over the occiput producing a characteristic waveform. Abnormalities may be seen in a variety of pathologic processes involving the optic nerve and its radiations. Pattern-shift VER is a highly sensitive means of documenting lesions in the visual system.
Visual evoked potentials are appropriate for the following indications:
1. Confirm diagnosis of multiple sclerosis when clinical criteria are inconclusive
2. Evaluate diseases of the optic nerve, such as:
- Optic neuritis
- Ischemic optic neuropathy
- Toxic amblyopias
- Nutritional amblyopias
- Neoplasms compressing the anterior visual pathways
- Optic nerve injury or atrophy
- Malingering/functional vision loss (to rule out)
3. Monitor the visual system during optic nerve (or related) surgery (monitoring of short-latency evoked potential studies).
VEP in Glaucoma
A 2011 report by the AAO on “Assessment of Visual Function in Glaucoma” noted that while VEP, as an objective measure of visual function, provided testing free of patient input, issues prevent their adoption for glaucoma management. It concluded that advances in technology have yet to produce definitive guidance on the diagnosis of glaucoma or its progression over time and that further research on an objective measure of visual function is needed.
Since then several studies have investigated the use of VEP technology to differentiate between normal healthy eyes and eyes with early to advanced visual field loss resulting from glaucoma. The authors indicated that VEP may allow earlier diagnosis of glaucoma. However, NGS has determined that without larger studies, AAO’s 2011 conclusion, that these technologies have yet to produce definitive guidance on the diagnosis of glaucoma or its progression over time, remains. This was also the conclusion of a 2013 study which prospectively monitored progressive changes of RGC function in early glaucoma using PERG. The authors concluded that further follow-up is required to determine whether PERG losses are predictors of future visual field loss.
Neither of the 2015 AAO Preferred Practice Guidelines, “Primary Open-Angle Glaucoma Suspect” or “Primary Open-Angle Glaucoma,” mention VEP as diagnostic tools. Also, the UpToDate review on “Open-angle glaucoma: Epidemiology, clinical presentation, and diagnosis,” likewise omits reference to either test.
There remain no verified guidelines for normal vs abnormal that would be easily applicable to an individual patient. NGS, therefore, considers the use of VEP for either glaucoma diagnosis or management investigational.
Limitations
Testing shall be performed by physicians who have evidence of knowledge, training, and expertise to perform and interpret these tests. This training and expertise must have been acquired within the framework of an accredited school, residency or fellowship program.
ICD-10 Diagnosis Codes
1. All documentation must be maintained in the patient’s medical record and made available to the contractor upon request.
2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service(s)). The documentation must include the legible signature of the optometrist or ophthalmologist responsible for and providing the care to the patient.
3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
4. The medical record documentation must support the medical necessity of the services as directed in this policy.
5. The patient’s medical record must contain documentation that fully supports the medical necessity for NEPs as covered by Medicare. This documentation includes, but is not limited to, relevant medical history, physical examination and results of pertinent diagnostic tests or procedures.
1. Report a VEP with CPT code 95930. This is a bilateral test, therefore no modifiers are required if both eyes are examined. A unit of “1” is placed in the unit field of the CMS 1500 form or its electronic equivalent.
2. A VEP test is usually reported globally, but it may be separated into a professional component (modifier -26 and a technical component (modifier -TC) if necessary.
3. VEP test can be done with general or direct supervision by the optometrist/ophthalmologist depending on if the technician is certified or non-technicians are now able to become certified by the American Board of Physical Therapy Specialties (ABPTS) to perform sensitive and complex neurophysiological studies. If your technician is certified, a VEP test may be performed under general supervision (the doctor is not immediately available). If your technician is not ABPTS certified, a VEP test must be performed with direct supervision (doctor is immediately available).
4. An eye examination may be reported on the same day as a visual evoked potential test if it is medically necessary.
In general, VEP testing is reimbursed when it is reasonable and medically necessary. Since there are no published utilization guidelines for VEP testing, doctors should adhere to CMS Ruling 95-1 (V) which states that utilization of VEP testing should be consistent with locally acceptable standards of practice.
According to the International Society for Clinical Electrophysiology of Vision, a minimum of two VEP recordings should be acquired, measured, and displayed to confirm the reproducibility of data if the findings are abnormal. Also, it is usually not medically necessary to perform more than two VEP tests in a twelve-month period to diagnose and treat optic nerve disease.