Otolaryngology Coding Alert

Question: Can I report cochlear implant programming bilaterally?

Wisconsin Subscriber

Answer: No, unfortunately, the coding for this service has not caught up with standard practices. You cannot currently report the programming codes 92601-92604 (Diagnostic analysis of cochlear implant ...) bilaterally. On Medicare's fee schedule, the procedures have a bilateral code indicator of "0," which means you can't append modifier 50 (Bilateral procedure).

Why: Bilateral cochlear implants are a relatively new development. When the AMA developed and valued codes 92601-92604, no one envisioned performing bilateral cochlear implant surgery or activating both devices in the same visit.

Best advice: The best way to address the problem is to appeal to Medicare to remove the status indicator "0" for bilateral payment. The American Academy of Audiology and American Speech-Language-Hearing Association already have petitioned CMS about a change in the status indicator for bilateral payment for programming cochlear implants.

Contacts: If you've been rejected for a bilateral claim of 92601-92604, contact the appropriate professional association: dabel@audiology.org, actioncenter@asha.org, or reimbursement@entnet.org. Meanwhile, if you're dealing with a third-party payer or commercial insurer, you may have more leeway, so contact the specific payer for guidance.

If none is forthcoming, code with the anatomical modifiers RT (Right side) and LT (Left side) to indicate binaural cochlear implants. Another option is to put modifier 59 (Distinct procedural service) on the second side along with the LT modifier.

Example: Your ENT puts two cochlear implants into a 6-year-old patient. A month later, your audiologist initializes and programs both of the child's implants. You would code 92601-RT and 92601-LT or 92601-59-LT (Diagnostic analysis of cochlear implant, patient younger than 7 years of age; with programming).

When the young patient comes in for subsequent testing, you would report 92602-RT and 92602-LT. Remember, the initial stimulation codes (92601, 92603) are intended to be billed on the first day of activation only.