Part B Insider (Multispecialty) Coding Alert

Published on Sat Jun 24, 2006 PDF

Helpful hint:  Medicare will reimburse you if your audiologist prepares properly

If there’s no specific CPT Code to describe an audiologic test, don’t assume an unlisted-services code is your only option. Find out how to get Medicare to pay for a Gans Sensory Organization Performance Test (SOP) …quot; and reduce your chances of denial.

First step: You must make sure the SOP you’re coding is distinct from a Sensory Organization Test (SOT) performed as part of computerized dynamic posturography (CDP), which has its own code (92548), says Robert C. Fifer, PhD, director of audiology and speech-language pathology at the University of Miami’s Mailman Center for Child Development in Florida.

The choices: Once you’ve established that your SOP is not bundled into a CDP code, you might choose to report the entire SOP under 97750 (Physical performance test or measurement…). But Medicare won’t reimburse an audiologist who bills this--your chances are better with a private carrier. For Medicare, you should try reporting the entire test under code 92700 (Unlisted otorhinolaryngological service or procedure).

Strategy: Each time you report 92700, be prepared to do a little extra paperwork for proper reimbursement. Provide a detailed account of the symptoms and concerns of the patient, including reasons for the referral, urges Fifer. Next, provide a detailed description of the procedure, including how long it took, what exactly was done and the equipment involved, he suggests. Let the insurer know what you found (clinical assessment and conclusions from the diagnostic results) and what you recommend as the next step, based on both the history and the findings.

Best bet: Have the audiologist, rather than the coder, provide this documentation, because any audit is going to focus on the person who holds the professional license and ultimate responsibility, Fifer advises.