Otolaryngology Coding Alert

Reimbursement matches MD's when audiologist bills 92552-92557 and more

Don't let incident-to and diagnostic service guidelines muddy the waters when coding for audiologist-performed hearing and vestibular services. You could be making claims blind using incident-to instead of giving the audiologist due credit.

Have Audiologists Use Own Numbers

Myth #1: The first myth you have to debunk goes something like this: You have to know the ins and outs of incident-to when billing audiology services. Reality: You can forget these details.

Why: Diagnostic audiological services have earned their own benefit category from CMS, says Kadyn Williams, AuD, chair of the American Academy of Audiology (AAA) coding and reimbursement committee. That means, -technically, diagnostic audiology services by an audiologist should never be billed incident-to.-

Instead: You should report an audiologist's services using his own provider identification number (PIN)/unique physician identification number (UPIN) or, as of May 23, 2007, his own national provider identifier (NPI). -Audiologists are professionally able to bill independently and should be billing that way,- says Williams, who is also co-director of Audiological Consultants of Atlanta.

Check for Qualifying Codes

Myth #2: Billing independently opens all the codes on your otolaryngology practice's super bill to your audiologist. Not true. 

Reality: -Audiologists are able to bill diagnostic codes but are prohibited from billing Medicare for treatment codes,- according to Paul Pessis, AuD, in his audio conference -Code Blue: More on Reimbursement.- For instance, an audiologist cannot bill cerumen removal (69210, Removal impacted cerumen [separate procedure], one or both ears) to Medicare, -- because CPT code 69210 is a treatment code.-

But specific regulations apply to diagnostic codes. -Hearing and vestibular procedures have their own separate benefit category as -other diagnostic tests,- - says Lisa Miller Jones, MS, director of reimbursement for the AAA in Reston, Va.

Tip: You can easily identify diagnostic test codes by looking at column -AF- of the 2007 Medicare Physician Fee Schedule. A designation of -5- indicates -Physician supervision policy does not apply when procedure is furnished by a qualified audiologist; otherwise must be performed under the general supervision of a physician.-

Diagnostic testing codes include hearing and balance services. Applicable codes include:

- audiologic tests from 92552 to 92557; 92561-92584.
- the technical portion (modifier TC) of vestibular function tests 92541-92546 and 92548. For a full list of these codes, see box below.
 
Expect Same Payment for AuD Billing

Myth #3: Your office manager worries that billing for diagnostic tests under your audiologist's number will mean less money. Set her straight.

Nonphysician practitioners (NPPs) who are unable to bill Medicare independently for their services  are subjected to a payment reduction. -However, audiologists are able to bill  Medicare as independent practitioners and therefore receive 100 percent of the Medicare Physician Fee Schedule  payment,- Jones says.

Note: The February 2007 Otolaryngology Coding Alert reader question -Apply Incident-to Rules to Tech Audios- erroneously stated that the reduction applied to audiologists.

Important: A physician must still make the referral in order for Medicare Part B to cover the services. Diagnostic testing by a qualified audiologist -is paid for when a physician orders testing to obtain information as part of his/her diagnostic evaluation, or to determine the appropriate medical or surgical treatment of a hearing deficit or related medical problem,- stipulates Wisconsin Physicians Service Insurance Corp. (Medicare Part B carrier for Wisconsin, Illinois, Michigan and Minnesota) in its national coverage policy -Audiology Services.-

Use Form to Route Payment to Practice

Myth #4: My physicians think our practice will have an easier time obtaining reimbursement if we file audiologist-performed services using an otolaryngologist's number instead of the audiologist-s. But you can route payments for audiologist-billed services the same way individual otolaryngologists do in a group practice.

Action: Have your practice-employed audiologists fill out form 855R, which allows payment to flow directly to the group practice, Williams says.
 
Capture NonAuD Services Incident-To

Myth #5: It is often thought that incident-to billing never applies to diagnostic audiology services. You should instead realize that a time and a place exist for incident-to with such services.

Do this: When a technician conducts diagnostic tests, the service must meet incident-to criteria to be billable.