Otolaryngology Coding Alert

Question: Medicare is retracting payment for hearing tests if the patient came from a skilled nursing facility. They are saying that the facility is responsible for the payment. How should we handle this?


Connecticut Subscriber


Answer: The Balanced Budget Act of 1997 requires skilled nursing facilities (SNFs) to consolidate their billing for Medicare Part A, and some Part B, residents. To ensure your practice gets its due when seeing SNF patients, you should discuss payment for SNF services with the facility prior to the visit.

If Part A Medicare covers the patient, Medicare pays the SNF for all the patient services under -consolidated billing.- Therefore, you must contract with the SNF directly for payment. Medicare won't pay you for services provided to a patient in a Part A stay.

For Medicare Part B patients, the rules are slightly different. You may report E/M services or other purely -professional- services directly to Medicare for payment.  For diagnostic tests (including hearing tests) or any procedures with both a -technical- and -professional- component, however, you should report only the professional component to Medicare. You must bill the SNF for the technical component of the service.

Example: The otolaryngologist provides a pure tone hearing exam (92552, Pure tone audiometry [threshold]; air only) for a Part B SNF patient in the office, using his own equipment. In this case, you will report the professional component of the service to Medicare as 92552-26 (Professional component). This pays for the physician's effort in performing and interpreting the test.

You should then report 92552-TC (Technical component) directly to the SNF for use of the physician's equipment, staff, etc. Medicare allots payment to the SNF for such expenses, and the SNF should pay you for the technical component of any diagnostic tests.

Why it matters: Medicare only wants to pay for a service once. If the SNF sends in a claim for your ENT's service, Medicare will reimburse the SNF--not the ENT. Clinical and coding expertise for You Be the Coder and Reader Questions provided by Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.; and Charles F. Koopmann Jr., MD, MHSA, professor and associate chair at the University of Michigan's department of otolaryngology in Ann Arbor.