Final Exam Vest Injury,ENG & Billing/Coding

Question 1

for acute unilateral deficits the fast phase of the nystagmus typically beats ____

Answer 1

for acute unilateral deficits the fast phase of the nystagmus typically beats away from the damaged ear.

Left caloric weakness = right-beating spontaneous (static) nystgamus

Question 2

True or False

Vestibular pathways remain uncomponsated following unilateral damage

Answer 2

FALSE
Vestibular pathways undergo compensatory changes following unilateral damage

Question 3

How is that after uniltaeral damage we are able to meaure caloric weakness?

Answer 3

Shortly after a unilateral insult, the resting neural activity on the damaged side decreases.
* This is also why ‘perceptually’ the person experiences vertigo

And the Tonal imbalance produces spontaneous nystgmus.

Question 4

Post injury why does a person ‘perceptually’ experiences vertigo?

Answer 4

Shortly after a unilateral insult, the resting neural activity on the damaged side decreases.

Question 5

For acute unilateral deficits, the tonal imbalance of the strong side drives the eyes ____ ______ the weaker side. The brain’s compensatory mechanism is a ____ ____ back the other direction the affected side.

Answer 5

For acute unilateral deficits, the tonal imbalance of the strong side drives the eyes slowly toward the weaker side. The brain’s compensatory mechanism is a rapid jerk back the other direction (fast phase nystagmus)

Beats away from affected side

Question 6

what is a uncompensated peripheral loss for an acute unilateral deficit.

Answer 6

• the resting neural activity on the damaged side decreases.
• measuring a caloric weakness on the damaged sidee
• Perceptual vertigo
• Tonal imbalance produces spontaneous nystagmus
• acute unilateral deficits the fast phase of the nystagmus typically beats away from the damaged ear.

Question 7

What is Cetral Compensation?

Question 8

Steps of Central Compensation

Answer 8

1. Reducing neural actvity on the unaffected side (good ear)
2. Overtime (D/W) the good side slowly lets up “claming down” as the damaged side’s resting Neural activity is restored
3. Once Static Compensation is achieved spontaneous nystgamus will disappear & the PT’s Symptoms will improve as head is still - head motion will still provoke symptoms
4. Dynamic compensation, reprogramming VOR pathway to deal w/long term effects of Labyrinthine loss and vestibular function on damaged side

Question 9

What does the “clamping down” process due doing central compensation?

Answer 9

• decrases the resting neural activity on the good side
• Reduced the asymmetry = improves patients vertigo symptoms

Question 10

True or False

Once static compensation is achieved the spontaneous nystagmus will disappear and the patient’s symptoms will improve and return to normal.

Answer 10

FALSE
Once static compensation is achieved the spontaneous nystagmus will disappear and the patient’s symptoms will improve as long as their head remains still. Head motion at this point will still provoke symptoms though

Question 11

___ is achieved the spontaneous nystagmus will disappear and the patient’s symptoms will improve as long as their head remains still. Head motion at this point will still provoke symptoms though

Answer 11

static compensation

Question 12

What is Static Compensation

Answer 12

Is the restoration of balance function & equalibrium of resting neural activity in both ears while the body is at rest (when the head is still.)
* Symptoms improve when head is still

Question 13

Reprogramming of the VOR pathways to deal with the long-term effects of labyrinthine loss on the damaged side

Answer 13

Dynamic Compensation

Question 14

What is dynamic Compensation?

Answer 14

• The last stage of compensation
• reprogramming VOR pathways to deal with the long-term effects of labyrinthine loss on the damaged side
• the individual functionally returns to normal. (Can be sped-up by VRT/VR exercises.)
• caloric test will ALWAYS show the weakness throughout the whole process and from there forward (permanency)

Question 15

What Can be sped-up by VRT/VR exercises.

Answer 15

Dynamic Compensation

Question 16

True or False

Once dynamic compensation is achieved the individual functionally returns to normal. Calorics will reflect normal as a sign of sucessfull compensation.

Answer 16

FALSE
Once dynamic compensation is achieved the individual functionally returns to normal. Calorics will ALWAYS show the vestibular weakness throughout the whole process and from there forward (permanency)

Question 17

True or False

Once dynamic compensation is achieved the individual functionally returns to normal. Calorics will always show vestibular weakness.

Answer 17

TRUE
Once dynamic compensation is achieved the individual functionally returns to normal. Calorics will ALWAYS show the vestibular weakness throughout the whole process and from there forward (permanency)

Question 18

In order to have good compensation you mst have what?

Answer 18

In order to have good compensation you must have an intact cerebellum (flocculus & paraflocculus specifically)

Question 19

True or False

Calorics will not show the level of functional compensation

Answer 19

TRUE
Calorics will not show the level of functional compensation - rotary chair will.

Question 20

If you have an abnormal finding on an oculomotor exam….

Answer 20

re-instruct and repeat it
* a True abnormal will always remain abnormal

Question 21

For oculomotor data points use a conservative criteria of ____ or _____ data points for abnormal/normal criteria

Answer 21

For oculomotor data points use a conservative criteria of 50% or more data points for abnormal/normal criteria

Question 21

True or False

Patient tasking or alerting should be performed during static positional testing?

Answer 21

TRUE

Question 22

For ENG/VNG technical issues make sure to be aware of what?

Answer 22

Be aware of potential patient confounding factors such as poor vision, eye abnormalities, fatigue, medication effects or inability to perform tasks

Question 23

For ocularmotor result data points, what is abnormal

Answer 23

For result data points, 50% or more in abnormal area = abnormal

Question 24

# ENG/VNG Tech Issues For positional testing turn patient head before recording to avoid what?

Answer 24

For positional testing turn patient head before recording to avoid appearance of nystagmus on tracings generated by movement; be quick

Question 25

# ENG/VNG Tech Issues Instruct patient on importance of

Answer 25

Instruct patient on importance of keeping eyes open during positional testing, especially for BPPV

Question 26

___ and ____ your caloric data between irrigations

Answer 26

Clean up and verify your caloric data between irrigations

Question 27

# ENG/VNG tech Make sure to give patient ____ between irrigations and work in a _ order so you don’t have two irrigations in a row for ___ direction

Answer 27

Make sure to give patient 4-5 minutes between irrigations and work in a reverse order so you don’t have two irrigations in a row for same direction

Question 28

Videonystagmography (VNG) Codes

Answer 28

92540 92537 92538 * Reimbursement 2020: ~$150 for CMS

Question 29

92540 92537 92538

Answer 29

Videonystagmography (VNG) & ENG Codes

Question 30

Basic vestibular evaluation, (spontaneous nystagmus test with, recording, positional nysta (minimum of 4 positions), OPK

Answer 30

CPT 92540 | 40 - 4 positional tests

Question 31

# CPT Caloric, bilateral, bithermal (warm and cold)

Answer 31

CPT 92537 * think 37 younger then 38 second born = 2 = 2 temps

Question 32

Caloric, bilateral, monothermal (just warm or just cold)

Answer 32

CPT 92538 * think 38 older then 37 = first born = 1 = 1 temp

Question 33

CPT code for Saccdes

Answer 33

There is **no** code for saccades.

Question 34

vertical electrodes

Answer 34

May also bill 92547 ENG