Otolaryngology Coding Alert

Reader Question:

Use 92597 Over E/M Visit for Voice Prosthetic Device Evaluation

Question: Following air and bone pure tone audiometry testing, the audiologist proceeded to discuss with the patient whether she would be a candidate for an electrolarynx. Can the provider bill for a separate evaluation and management (E/M) code in addition to the audiometry testing?

Oklahoma Subscriber

Answer: You’ll rarely encounter scenarios in which an audiologist encounter will meet the criteria for a separate E/M visit in addition to the underlying service. Furthermore, in this clinical scenario, there is a code that might encompass the provider’s services, depending on the extent of the evaluation process.

In addition to the coding of 92553 (Pure tone audiometry (threshold); air and bone), you’ve got to examine the component of the patient visit that involves the evaluation of electrolarynx in order to determine whether you’ve got enough to support code 92597 (Evaluation for use and/ or fitting of voice prosthetic device to supplement oral speech), as well. You’d typically code 92597 when the provider fits the patient for an electrolarynx, speaking valve, or other voice prosthetic device. However, as the code description suggests, an extensive evaluation without a fitting may also qualify.

Specifically, you’ll need to document more than just a set of basic questions in order to reach the criteria needed for 92597. At the very least, the audiologist should perform a series of tests to help make a better determination of the patient’s needs. For example, a formal evaluation should involve measurements and testing of the patient’s vocal capacity in order to determine whether the patient is a candidate for a voice prosthetic device — and if so, which device is most appropriate.