Otolaryngology Coding Alert

Question: Has anyone had any trouble having 92531 and 92532 bundled with an E/M service? The claim was also denied on appeal. I could not find this edit in CCI.

Alaska Subscriber

Answer: Hundreds of medicine and diagnostic test codes were bundled with E/M services in version 6.3 of the national Correct Coding Initiative (CCI). The edits were withdrawn three months later following an outcry by physicians and because the HCFA directive was not applied consistently across the country, says Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist in Lakewood, N.J.

Some carriers, however, have yet to remove the edit, which required that modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) be appended to any E/M service billed during the same session as a diagnostic test, such as 92531 (spontaneous nystagmus, including gaze) and 92532 (positional nystagmus). Therefore, you may need to resubmit your E/M service with modifier -25 appended to the appropriate E/M code. This indicates to the carrier that the evaluation and management service provided was not simply a pretest evaluation which would be included in the test.

Although HCFA says the edits may be reinstated as early as July 2001 (following an education campaign aimed at physicians and carriers), carriers that still require modifier -25 are violating HCFAs Dec. 21, 2000 directive suspending the edits. The oversight should be brought to the carriers attention, Cobuzzi says.