Otolaryngology Coding Alert

CPT is very clear about what qualifies for 92543 Does Medicare Allow In-House Audio Referrals? Test your testing referral knowledge with this scenario submitted by Lisa Hanson, office manager at Coastal Ear, Nose and Throat LLC in Wall, N.J. -We are a multi-physician otolaryngology practice with two in-house audiologists who perform testing and dispense hearing aids,- she says. -The audiologists are employees of the physicians, and everything is billed under the same tax ID.

-Medicare requires physician referrals for audiology testing. Can our physicians, after performing a patient history, examination and medical decision-making, refer the patient to our own audiology department for testing or do we have to have outside physician referrals?- Hanson asks.

Advice: An in-house referral does meet Medicare's referral requirement. -After the patient sees the physician, if an audio is needed, the patient can walk over to the audiology department and get the audio,- says Janet Agemian, CPC, administrator at Regional Otolaryngology Associates LLC in Voorhees, N.J. In this case, you should bill the testing, such as 92557 (Comprehensive audiometry threshold evaluation and speech recognition [92553 and 92556 combined]), under the physician's provider number, she says.

Should You Unbundle Hearing Aid Services? In coding circles, the term -unbundling- can have a very negative connotation, but when it comes to hearing aids, breaking out line-item prices for everything involved is the way to go and is permissible.

Most ENT practices lump all of their hearing aid-related services -- batteries, ear molds, rechecks, dispensing fee -- into a total package. While that might be easier for the patient to grasp quickly, it could cost your practice money.

Better way: Have the information broken out so you can create an accurate bill for insurance and a fair price for yourselves. -If it's billed to insurance, it needs to be broken down,- says Debbie Abel, AuD, American Academy of Audiology board member, liaison to the AAA Coding and Practice Management Committee, and a private-practice audiologist in Poway, Calif.

Insurance companies will typically pay the invoice cost of the hearing aid, and they may pay the dispensing fee or an amount above the cost of the aid, anywhere from $150 to $700 depending on the carrier, your contract with the carrier, and the patient's insurance benefit. The invoice cost and dispensing fee need to be billed separately if your contract with the insurance company stipulates payment for both, Abel says.

-If you bill for the hearing aid as a whole,- Abel says, -you-re only going to get reimbursed for the invoice cost.- Unbundling benefits patient relations as well, Abel says: -When you unbundle, the patient understands the breadth and quality of the services an audiologist provides.-

For testing, relevant CPT codes include:

- 92590 -- Hearing aid examination and selection; monaural

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