Otolaryngology Coding Alert

Great news: This vestibular test now falls under a specific code Be sure you take advantage of a timesaving new method for coding air irrigations.

You no longer have to file the extra paperwork associated with using an unlisted- procedure code when you charge for a caloric vestibular test involving air, now that the AMA instructs you to use a specific code for this procedure. Here are the details on this change. Fact 1: Use 92543, Not 92700, for Air Irrigation The AMA weighed in on what counts as irrigation for electronystagmography (ENG) test code 92543 (Caloric vestibular test, each irrigation [binaural, bithermal stimulation constitutes four tests], with recording). -There is a clarification from the AMA on this procedure code in the September 2006 CPT Assistant on page 13,- says Chrissy Letsen, CPC, education and auditing specialist at Metropolitan ENT in Alexandria, Va.

The AMA now classifies air irrigation as 92543. In the past, if you used air, you had to use unlisted-procedure code 92700 (Unlisted otorhinolaryngological service or procedure), Letsen says. Fact 2: Bill Up to 4 Units of 92543 Two types of irrigation now fall under 92543: air irrigation and water irrigation, which coders have historically reported with 92543.

Tip: You can use the AMA's September question and answer -Coding Communication: Special Otorhinolaryngologic Services- to combat any payers that disallow billing multiple units of 92543. The article also stated that if an audiologist performs both cold and warm irrigations on both sides, you should bill a total of four units, Letsen says.

Be careful: You should never report more than four units of the code. -Audio-logists would perform the irrigations with either air or water, not both,- says Debbie Abel, AuD, a member of the American Academy of Audiology board of directors.

-Air calorics are performed in the same binaural, bithermal stimulation manner as water calorics, with both ears being stimulated with cold air and both sides stimulated with warm air to account for four units, with recording,- according to CPT Assistant, September 2006. In addition, -the use of air as opposed to irrigation by water for caloric stimulation has been available since the 1980s and is, in many cases, a preferable method with many patients undergoing electronystagmography.-

New method: An audiologist irrigates a patient's ears (binaural) with two air temperatures (bithermal). Report four units of 92543 to indicate four irrigations:

- one cold air right ear

- one cold air left ear

- one warm air right ear

- one warm air left ear