Tympanogram and Office Visit on Same Day

nsclark2

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We are coming across some instances where a tympanogram was done along with an office visit with the same dx code. Patient came in for a follow up check after tubes were done in 2007. Tympanogram and office visit was billed with dx code V45.89. They denied the tympanogram. Any thoughts?
 

b.cobuzzi

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If this is a Medicare patient, there is a different code, a G code that is supposed to used when an EM is performed by the physician and audiology performed by the audiologist, it is G0268 for the audiology.

If it is not Medicare, you may be stuck with a payer who is assigning a global to the audiiology even though it should not have a global period (xxx global period has no global). NCCI 7.3 said in the verbiage that they assigned the same global as zero and 10 day global procedures to xxx global procedures. Some payers picked up on that. If so, you need to have a significantly separately identifiable EM done and documented from the audiology. And when you do, you need a 25 modifier on your em. Appeal and hopefully your em notes will support the 25 mofifier. Good luck

Barbara Cobuzzi, CPC, CENTC
 
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