Medical Necessity Letter for Videonystagmography (VNG) Testing/ Balance Testing

Medical necessity letter for Videonystagmography (VNG) Testing/ Balance Testing

The above named patient has been treating conservatively for persistence of chronic pain. The patient has been treating at our facility for care in the form of “interventional pain management”. The patient’s working diagnosis and comorbidities of concern have been established and documented in their treatment reports/notes. The patient is prescribed to undergo a multiphase Videonystagmography (VNG) Testing/ Balance Testingstudy for conformational analysis of their condition. We are focusing our care based on an “evidenced based” approach to treatment intervention. Determination for this procedure is based on a reasonable degree of medical necessity. VNG tests will accurately diagnose at-risk patients by determining the presence of either a peripheral (inner ear & balance nerve) or central (brain & spinal cord) vestibular disorder.

The above-mentioned test is prescribed to rule out nerve deficit and to understand the extent to which nerves are involved and the following:

Syncope Collapse, Dizziness & Giddiness, Gait Abnormality, Vertigo-unspecified, Central Vertigo, History/Risk of fall, Meniere’s disease, Labyrinthitis

This patient is a candidate for Videonystagmography (VNG) Testing as they have experienced one or more of the following:

• MVA affecting the cervical spine which can lead to disruption of coordination of sensory information to the cerebellum and cervical feedback loop neurologically.
• Any degenerative joint disease in the cervical spine
• Any history of falling or history vertigo
• Patients with a history of diabetic neuropathy
• Patients with a history of lumbar disc herniation contributing to sciatic neuropathy and other lower extremity neurologic and vascular compromises.
• Chemical toxicity from industrial exposure – lead, Mercury and other contaminants
• History of direct blunt head traumas from sports injuries or motor vehicle trauma or combat.
• Failed the hearing exam, or report any ringing of the ears/tinnitus

There are multiple areas affecting balance and coordination including: Vestibulo-Occular Complex (eyes), Vestibulo-Cochlear Complex (inner ear) and Somatosensory Inputs associated with the brainstem/cerebellum and other lobes of cerebrum for integration and coordination of movements. Determination has to be made as to whether or not there is functional disruption. VNG testing will allow a clear understanding of this. If positive findings are noted, the patient will be referred for a neurologic evaluation with an appropriate specialist. The testing will be performed by an occupational therapist/technician. The results will be read by a physician specializing in this form of testing. Results will be reviewed with the patient thereafter. Early detection of neurologic induced balance disruption and postural weakness can help prevent severe falling accidents or risk.