Modifier Coding Alert
Try Modifier 22 for Two AEP Tests
PDF
Question: In order to determine frequency-specific testing results for a patient, my physician performed two comprehensive AEP tests in one session, click auditory brain response (ABR), and tone burst ABR. Would this be considered 92585 comprehensive or 92586 limited and how could get paid for both?
Wisconsin Subscriber
Answer: If your physician had only performed one of these auditory evoked potential (AEP) tests in one session, using 92585 (Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive) could be justified. Attaching modifier 22 (Increased procedural services) to 92585 may be the best way to be reimbursed for two AEP tests in one session.
Each of these tests on its own could justify reporting of 92585, so recouping payment may vary by payer.
You could try using the units field on your claim to record 92585 x 2. But it will depend on your payer whether this works or not. You may be denied for multiple units.
Using modifier 22 is probably your best option. Although 92585 is not a time-based code, time can be a good marker for establishing an unusually long evaluation. For example, tone burst ABR can take as much time as performing conventional ABR in each ear.
Because all services include testing of both ears, use modifier 52 (Reduced services) if a test is performed on only one ear.
Modifier Coding Alert
- Modifier Partners:
Knowing When You Should -- And Shouldn't -- Attach Modifiers 26/TC Is Key to Proper Payment
Nail down when one modifier can be used alone. If your physician provides diagnostic or [...] - ICD-10 Delayed Another Year
It was not an April Fool’s Day joke when, on Tuesday, April 1, President Obama [...] - Correct Coding Initiative:
Override CCI Edits, When Appropriate, With Modifiers 51/59
Recognize that Medicare prefers you don’t use one of these modifiers. Depending on the clinical [...] - Calculate Your Fees
CPT® code 23412 relative value units = 24.33 Multiply 24.33 x 35.8228 (national conversion factor) [...] - You Be the Coder:
Alert Billing With Modifier GA
Question: How can I avoid writing off charges for services if I know Medicare will deny [...] - Clip and Save:
Answer the Questions in This Chart to Make Correct Modifier 59 Decisions
Guard against overriding every ‘1’ bundle. You’re not alone if you think that you can [...] - Reader Question:
Try Modifier 22 for Two AEP Tests
Question: In order to determine frequency-specific testing results for a patient, my physician performed two comprehensive [...] - Reader Question:
Mind Your P Modifiers
Question: I need to determine which physical status modifier to use for a surgery involving a [...] - Reader Question:
Don't Lose Focus of Medical Necessity
Question: One of our providers did a left heart catheter with a left/right coronary angiogram, and [...] - Reader Question:
Base Use of Exclusion Modifiers on the Encounter
Question: My physician is treating a patient for services where we are able to use the [...]