Otolaryngology Coding Alert

Start by knowing what’s included in the E/M visit.

Audiologic function testing is an important component of most ENT practices, but the job requirement of otolaryngology coders is often to focus exclusively on the ENT portion of the practice. “In my case, the audiology group is a separate department from the otolaryngology group, but they are housed within the same clinic,” says Kimberly Quinlan, CPC, senior medical records coder for the University of Rochester Medical Center’s Department of Otolaryngology in Rochester, New York.

However, that doesn’t mean that you shouldn’t be fully prepared to handle audiology coding duties if and when the time comes. That means staying on top of all the coding processes that come into play when reporting these services — especially audiologic function testing.

Keep handy these six helpful pointers to keep your audiologic function test claims coding running smoothly and efficiently.

1. Determine Which Tests Are Included in the E/M Service

The easiest way to distinguish between an audiologic function test and a basic hearing test is by confirming the use, or non-use, of calibrated electronic equipment. This equipment allows the provider to record the results and provide a subsequent interpretation of the results. More specifically, the results will be detailed in graph form for the provider to then offer an interpretation of the graph.

On the other hand, the provider may perform a series of basic hearing tests (tuning fork, whispered voice, finger rub), which do not meet the criteria for an audiologic function test. CPT^® Assistant (August 2014; Volume 24: Issue 8) further reiterates the point by explaining that these such procedures “are considered part of general otorhinolaryngologic services included in E/M services, and are therefore, not reported separately.”

2. Pinpoint Key Differentiating Features Between 92551 and 92552

The underlying difference between 92551 (Screening test, pure tone, air only) and 92552 (Pure tone audiometry (threshold); air only) is that 92551 is utilized as a screening examination, whereas 92552 is utilized as a diagnostic examination. The examination involved in 92552 is therefore more comprehensive and results in a generated diagnosis; 92551, on the other hand, results in the patient either passing the exam or failing the exam and being referred for additional testing.

More specifically, when the provider is performing a screening test, the patient will be instructed to respond to a series of tones at various octaves, but with the intensity level remaining constant. A threshold examination will vary the levels of intensity as well as frequency in order to better gauge the softest level a patient can hear.

Note: Intensity level simply refers to the volume level of the tone. Frequency refers to the pitch of the tone.

3. Consider These Newborn Hearing Screening Coding Options

You should not consider code 92551 when performing a hearing screening on a newborn or infant. CPT^® Assistant explains that “while this procedure may be used for persons of various ages, it is not appropriate to use this code to report hearing screenings performed on newborns and infants.”

Rather, you should report one of two codes depending on the type of screening test the provider performs:

• 92586 — Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; limited
• 92558 — Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis.

You will report 92586 when the provider performs an auditory brainstem response (ABR) test, in which electrical responses, also known as auditory evoked potentials, are documented and recorded in response to auditory stimuli. The 92558 code, on the other hand, measures the cochlear status (hair cell function) in response to pairs of tones at specific frequencies.

4. Know When to Combine Select Codes

If you’re new to audiology coding, you should get a rundown of which codes to report when the audiologist performs a series of tests. Some codes, for instance, can be combined into a more comprehensive CPT^® code.

For example, instead of reporting 92567 (Tympanometry (impedance testing)) with 92568 (Acoustic reflex testing, threshold), you should report the all-encompassing code 92550 (Tympanometry and reflex threshold measurements). Additionally, when the provider performs 92553 (Pure tone audiometry (threshold); air and bone) and 92556 (Speech audiometry threshold; with speech recognition) during the same encounter, you will opt to report the comprehensive code 92557 (Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined)).

5. Don’t Forget About Automated Category III Codes

If your practice offers forms of automated pure tone audiometry, then you should look no further than the following category III codes:

• 0208T — Pure tone audiometry (threshold), automated; air only
• 0209T — Pure tone audiometry (threshold), automated; air and bone.

These codes are relatively straightforward. They should be reported when patients utilize a computerized display unit (PC or tablet) to listen to the tones and document their responses.

6. Use Modifier 52 for Unilateral Services

Finally, it’s important to know which audiologic testing codes are inherently bilateral. Have a look at this National Correct Coding Initiative (NCCI, or CCI) Policy Manual guideline:

• “Audiologic function testing (CPT^® codes 92550-92588) includes testing of both ears, and only 1 unit of service for any of these CPT^® codes may be reported for the described testing on both ears. If only one ear is tested, the appropriate CPT^® code should be reported with modifier 52 (Reduced Services).”