Combine Audiologic Function Test Combos Into 3 New Global Codes
Avoid these 3 pitfalls for pitch-perfect claims. Although this may seem like your job just got easier, you should avoid these major pitfalls come Jan. 1 -- and watch out for decreases to your bottom line. Background: • 92540 -- Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording • 92550 -- Tympanometry and reflex threshold measurements • 92570 -- Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing. Example: Pitfall #1: You Report More Than 1 Component If your audiologist performs only one or two of the tests included in the global service, you should not use the global codes. Instead, you should use the individual codes representing each test. Example: Problem: For each of these codes, CPT instructs you not to report them with the other components. For instance, underneath 92541, you'll see "Do not report 92541 in conjunction with 92542, 92544, 92545," according to CPT. In other words, you can only report one component. If you wish to reflect the three out of four tests, you should report 92540-52 (Reduced services). Pitfall #2: You Don't Strike Off 92569 Because of the audiologic requirements for 92569 (Acousting reflex testing), audiologists cannot do this test in isolation " audiologists always perform acoustic reflex decay testing in conjunction with tympanometry and acoustic reflex threshold testing, says Debbie Abel, AuD, director of reimbursement of the American Academy of Audiology in Virginia. Replacement: Pitfall #3: You Confuse Tympanometry Codes Although you have a new code for tympanometry in 2010, you will still retain the old codes. Code 92550 will not replace 92567 (Tympanometry [impedance testing]), Abel says. Code 92567 is for when the audiologist performs tympanometry to measure ear pressure without bundled tests. What CMS Gains, Practices Lose Bundling codes is a common occurrence, not only for audiology but for many other specialties. Saving money is the main impetus for CMS coming up with the new codes. Abel says. "CMS was looking at codes that were billed at the same time and trying to bundle them in order to save money," she says. This way, payers no longer need you to bill different components. In other words, when you do bundle with a new code, the value of the whole bundle goes down comparedto billing each test individually (code 92550 is the exception). These bundles affect codes that Medicare data identified as billed together by the same provider on the same day 95 percent of the time or more. Meanwhile, practices have not taken the news very well, says Abel. She believes that that with audiology codes sustaining the decreases that will go into effect on Jan 1, coupled with the decrease in reimbursement that occurs, bundling is not beneficial.
