Otolaryngology Coding Alert

Question: When my audiologists perform two warm and two cold calorics, they bill four units of caloric vestibular test code 92543. Does the code consist of four tests, so they should report one unit of 92543 for up to four tests? Are units and irrigations the same? Tennessee Subscriber Answer: The parenthetic notes in caloric vestibular test codes 92533 (Caloric vestibular test, each irrigation [binaural, bithermal stimulation constitutes four tests]) and 92543 (Caloric vestibular test, each irrigation [binaural, bithermal stimulation constitutes four tests], with recording) lead many coders to ask how many times to report these codes. These notes, however, describe a typical test that physicians often perform in both ears (binaural) at two temperatures (bithermal). The test involves irrigating an ear with water. Each irrigation is one test, according to CPT Assistant, May 1996. That's why the notes indicate that you should report four tests for the typical four-irrigation test.

If the physician irrigates one ear only or uses one temperature, you should report the corresponding number of irrigations. Choose the appropriate code based on whether the audiologist observes the patient's reactions (92533) or records them using electroneurography (ENG, 92543). For instance, if the audiologist irrigates the right ear with warm water without recording, report 92533. If she irrigates both ears with warm water, assign 92533 x 2. If three irrigations occur, bill 92533 x 3. And for a typical series of binaural, bithermal irrigations, record 92533 x 4. For carriers that do not accept units, you should bill one irrigation per line. Append modifier -59 (Distinct procedural service) to each multiple irrigation. For four irrigations, report:

92543
92543-59
92543-59
92543-59. If carriers deny individual irrigation reporting, remind them that although physicians normally perform four irrigations, CPT intends for physicians to bill the actual number performed. Some payers may erroneously believe that 92543 represents four irrigations based on Medicare News, May 1996. Medicare, however, reversed this stance and now states to bill 92543 based on the actual number of irrigations performed. For payers who are unaware of this mandate, send them copies of Medicare News, March 2000, available at www.gamedicare.com/NewsPubs/mar00/mar00p12.htm and CPT Assistant, May 1996.