Print | ShareCPT Code: 95930 Region: 09
States covered: Alabama, Georgia, Tennessee
Title: Visual Evoked Potential
Category
Electrodiagnostic Services
Description
Visual evoked potential testing
Visual evoked potential studies are recorded electrical responses to stimulation of a sensory system. When a sensory impulse reaches the brain, a specific Electroencephalographic (EEG) response is produced (evoked) in the cortical area appropriate to the modality and site of the stimulus. By computer averaging techniques, the evoked responses of repetitive stimuli can be separated from the spontaneous EEG activity. Evoked potentials are clinically useful in evaluating the functional integrity of the somatosensory or special sensory pathways. Different latencies and wave patterns help to localize lesions ranging from the end organ through the nervous system to the cerebral cortex. Often defects in these pathways are not otherwise evident. Evoked potentials are also used to monitor neural pathways when patients are anesthetized during surgery and to document brain death.
VEPs/VERs evaluate the visual nervous system pathways from the eyes to the occipital cortex of the brain. VEP or VER 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. This is called the Visual Evoked Response (VER) and is recorded by electroencephalography electrodes located over the occiput. Using special computer techniques, the evoked responses measured over multiple trials are amplified and averaged. A characteristic waveform is produced. With pattern-shift VER, the waveform normally appears as a straight line with a single positive peak (100 msec after stimulus presentation). Abnormalities in this characteristic waveform 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. It is especially useful when the disease process is subclinical, e.g., ophthalmologic exam is normal and patient lacks visual symptoms.
Visual evoked potentials are appropriate for the following indications:
1. Confirm diagnosis of multiple sclerosis when clinical criteria are inconclusive.
2. Detect optic neuritis at an early, subclinical stage.
3. 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 or atrophy
- Hysterical blindness (to rule out)
4. Monitor the visual system during optic nerve (or related) surgery (monitoring of short-latency evoked potential studies).
As published in CMS IOM 100-08, Chapter 13, Section 13.5.1, in order to be covered under Medicare, a service shall be reasonable and necessary. When appropriate, contractors shall describe the circumstances under which the proposed LCD for the service is considered reasonable and necessary under Section 1862 (a)(1)(A). Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is:
- Safe and effective
- Not experimental or investigational (exception: routine codes of qualifying clinical trial services with dates of service on or after September 19, 2000, that meet the requirements of the Clinical Trials NCD are considered reasonable and necessary
- Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:
- Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member
- Furnished in a setting appropriate to the patient’s medical needs and condition
- Ordered and furnished by qualified personnel
- One that meets, but does not exceed, the patient’s medical needs
- At least as beneficial as an existing and available medically appropriate alternative
ICD-10 Diagnosis Codes
| ICD-10 Codes | Description |
|---|---|
| A39.82 | Meningococcal retrobulbar neuritis |
| C70.0 - C70.9 | Malignant neoplasm of cerebral meninges - Malignant neoplasm of meninges, unspecified |
| C72.0 - C72.1 | Malignant neoplasm of spinal cord - Malignant neoplasm of cauda equina |
| C72.30 - C72.32 | Malignant neoplasm of unspecified optic nerve - Malignant neoplasm of left optic nerve |
| C72.9 | Malignant neoplasm of central nervous system, unspecified |
| C79.31 - C79.49 | Secondary malignant neoplasm of brain - Secondary malignant neoplasm of other parts of nervous system |
| D32.0 - D33.7 | Benign neoplasm of cerebral meninges - Benign neoplasm of other specified parts of central nervous system |
| D42.0 - D43.2 | Neoplasm of uncertain behavior of cerebral meninges - Neoplasm of uncertain behavior of brain, unspecified |
| D43.4 | Neoplasm of uncertain behavior of spinal cord |
| D44.3 - D44.5 | Neoplasm of uncertain behavior of pituitary gland - Neoplasm of uncertain behavior of pineal gland |
| D49.6 | Neoplasm of unspecified behavior of brain |
| G23.0 - G23.9 | Hallervorden-Spatz disease - Degenerative disease of basal ganglia, unspecified |
| G35 - G36.8 | Multiple sclerosis - Other specified acute disseminated demyelination |
| G37.0 - G37.8 | Diffuse sclerosis of central nervous system - Other specified demyelinating diseases of central nervous system |
| G90.3 | Multi-system degeneration of the autonomic nervous system |
| H35.54 | Dystrophies primarily involving the retinal pigment epithelium |
| H46.00 - H47.219 | Optic papillitis, unspecified eye - Primary optic atrophy, unspecified eye |
| H47.231 - H47.649 | Glaucomatous optic atrophy, right eye - Disorders of visual cortex in (due to) vascular disorders, unspecified side of brain |
| H53.001 - H53.8 | Unspecified amblyopia, right eye - Other visual disturbances |
| R44.1 | Visual hallucinations |
| R48.3 | Visual agnosia |
| S04.011A - S04.049S | Injury of optic nerve, right eye, initial encounter - Injury of visual cortex, unspecified side, sequela |
| S06.0X9A - S06.0X9S | Concussion with loss of consciousness of unspecified duration, initial encounter - Concussion with loss of consciousness of unspecified duration, sequela |
| S06.310A - S06.316S | Contusion and laceration of right cerebrum without loss of consciousness, initial encounter - Contusion and laceration of right cerebrum with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, sequela |
| S06.319A - S06.326S | Contusion and laceration of right cerebrum with loss of consciousness of unspecified duration, initial encounter - Contusion and laceration of left cerebrum with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, sequela |
| S06.329A - S06.336S | Contusion and laceration of left cerebrum with loss of consciousness of unspecified duration, initial encounter - Contusion and laceration of cerebrum, unspecified, with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, sequela |
| S06.339A - S06.346S | Contusion and laceration of cerebrum, unspecified, with loss of consciousness of unspecified duration, initial encounter - Traumatic hemorrhage of right cerebrum with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, sequela |
| S06.349A - S06.356S | Traumatic hemorrhage of right cerebrum with loss of consciousness of unspecified duration, initial encounter - Traumatic hemorrhage of left cerebrum with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, sequela |
| S06.359A - S06.366S | Traumatic hemorrhage of left cerebrum with loss of consciousness of unspecified duration, initial encounter - Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, sequela |
| S06.369A - S06.376S | Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of unspecified duration, initial encounter - Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, sequela |
| S06.379A - S06.386S | Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness of unspecified duration, initial encounter - Contusion, laceration, and hemorrhage of brainstem with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, sequela |
| S06.389A - S06.4X6S | Contusion, laceration, and hemorrhage of brainstem with loss of consciousness of unspecified duration, initial encounter - Epidural hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, sequela |
| S06.4X9A - S06.5X6S | Epidural hemorrhage with loss of consciousness of unspecified duration, initial encounter - Traumatic subdural hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, sequela |
| S06.5X9A - S06.6X6S | Traumatic subdural hemorrhage with loss of consciousness of unspecified duration, initial encounter - Traumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, sequela |
| S06.6X9A - S06.6X9S | Traumatic subarachnoid hemorrhage with loss of consciousness of unspecified duration, initial encounter - Traumatic subarachnoid hemorrhage with loss of consciousness of unspecified duration, sequela |
1. All coverage criteria must be clearly documented in the patient’s medical record and made available to Medicare upon request.
2. 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.
3. Documentation must support CMS ‘signature requirements’ as described in the Medicare Program Integrity Manual (Pub. 100-08), Chapter 3.
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).
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.