Appeal type: Experimental/Investigational
Decision: Overturned

Diagnosis: Dizziness. 

Treatment: Code 92548- Computerized dynamic posturography sensory organization test (CPD-SOT), 6 Conditions (i.e., eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform, and visual sway), including interpretation report.

The insurer denied coverage for code 92548- Computerized dynamic posturography sensory organization test (CPD-SOT), 6 Conditions (i.e., eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform, and visual sway), including interpretation report.

The denial is overturned. 

This is a female patient with a history of obstructive sleep apnea (OSA), atrial fibrillation, arthritis, cataracts, Crohn's disease, end stage liver disease, gastroesophageal reflux disease (GERD), hyperlipidemia, hypertension, hypothyroidism, migraines, and unspecified amblyopia. She underwent an audiological evaluation and the audiometric findings were all within normal limits. The reason for the audiological evaluation was stated as: Dizziness/imbalance with associated aural fullness/ pressure in the left ear and pulsatile tinnitus in the right ear. 

The peer-reviewed literature notes the use of computerized dynamic posturography to obtain information concerning balance function including visual and vestibular in patients with symptoms of dizziness or unsteadiness. 2-8  

In this case, the patient, as noted in her chief complaint, has experienced episodes of dizziness for a few days. The patient also noted fullness of her ears. The patient's audiogram was within normal limits which is not unusual for patient with suspected Meniere's disease. The clinical question that must be answered is whether or not the patient has any measurable disability of her vestibular system. The use of Computerized Dynamic Posturography would give information as to whether or not there are vestibular difficulties and if so, what their form is. This information would be used in initiating the appropriate intervention.

The scientific evidence in peer-reviewed literature supports a result of improvement in health outcome in that it could provide objective information to allow for appropriate interventions. Code 92548 - computerized posturography testing was approved by the Food and Drug Administration (FDA) in 1985. The patient is a good candidate as she has symptoms of dizziness and there needs objective information as to the status of her vestibular system so that appropriate interventions can be applied to her care. This requested diagnostic test is not treatment and is the best available diagnostic process available to define the locus of this patient's symptoms. This service ascertains the complete balance system including vestibular, visual and central nervous system. It is able to define if there is a physiological deficit or not, and allows appropriate interventions to be instituted.

The code 92548- Computerized dynamic posturography sensory organization test (CPD-SOT), 6 Conditions (i.e., eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform, and visual sway), including interpretation report is likely to be more beneficial than any of the standard treatments/procedures for this patient.

The carrier's denial of code 92548- Computerized dynamic posturography sensory organization test (CPD-SOT), 6 Conditions (i.e., eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform, and visual sway), including interpretation report should be overturned.