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Coding 92546 in Ohio

  1. Question Coding 92546 in Ohio
    Medical Coding Books
    Good morning,
    My practice has purchased a rotary chair, and we're going to start billing cpt 92546; I'm looking for something that I can read that offers a little more insight into how to bill for this bad boy. I have read the previous threads that state that most ins companies allow 2 units, while bcbs and mcr only allow 1, but this was in the state of CT. Does anyone know where I might be able to find more state specific information for Ohio? And if someone could point me in the right direction on the CMS website to check medicare's billing rules, I would appreciate it, I have a time of it trying to navigate that site.

    Thanks for your help,
    Sarah

  2. #2
    Location
    Columbia, MO
    Posts
    12,531
    Default
    I see nothing that allows for billing this procedure with units. the descrption states this tests function of left and right. Why would you bill with units?

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default Medicare assigns a "0" for 50 modifier
    Per Flashcode:
    "0=150% payment adjustment for bilateral procedures does not apply. If procedure is reported with
    modifier -50 or with modifiers RT and LT, base the payment for the two sides on the lower of: (a) the
    total actual charge for both sides or (b) 100% of the fee schedule amount for a single code. Example:
    The fee schedule amount for code XXXXX is $125. The physician reports code XXXXX-LT with an
    actual charge of $100 and XXXXX-RT with an actual charge of $100. Payment should be based on the
    fee schedule amount ($125) since it is lower than the total actual charges for the left and right sides
    ($200).
    The bilateral adjustment is inappropriate for codes in this category (a) because of physiology or
    anatomy, or (b) because the code description specifically states that it is a unilateral procedure and
    there is an existing code for the bilateral procedure."

    Also, 92546 is an inherently bilateral procedure.

  4. #4
    Location
    Jacksonville, FL
    Posts
    63
    Default units for 92546
    I have questions about this as well.
    I have a Physician that states he can bill CPT 92546 2x since he is also testing "horizontal". Some websites state that it can be billed per direction/per velocity.
    I know that BCBSF only allows one unit and I'm confused since there isn't anything from the CPT/AMA that specifically addresses the units issue.
    Anyone have hard evidence of which is correct?

  5. Thumbs up Wondering
    Quote Originally Posted by beckipoff View Post
    I have questions about this as well.
    I have a Physician that states he can bill CPT 92546 2x since he is also testing "horizontal". Some websites state that it can be billed per direction/per velocity.
    I know that BCBSF only allows one unit and I'm confused since there isn't anything from the CPT/AMA that specifically addresses the units issue.
    Anyone have hard evidence of which is correct?
    I'm still working on this one; it's been giving me fits. My head Audio states that more than one test can be performed with the rotary chair, even though the code doesn't specify any units. She has given me examples, and so I bill multiple units per her instruction. I have called some of the major payors for the area (Aetna, Anthem, UHC, MMOH), and they are all only paying 1 unit, except for Aetna, who told me there was no limit. I'm keeping an eye on things as this is a relatively recent code addition to our fee schedule. Any thoughts on how to go about gaining more reimbursement? I'm glad to hear I'm not the only one who has questions about this.

  6. #6
    Location
    Somers Point New Jersey
    Posts
    53
    Default Coding 92545 & 92546 in New Jersy
    Same question here !

    Our provider is performing oscillating tracking test; with recording & Sinusoidal Vertical axis rotational testing.

    we are coding CPT 92545 & CPT 92546.

    We have a document stating we should code these procedures for 2 units as oscillating tracking done by smooth pursuits & saccades.The tests are separate tests when VNG equipment is used. Also Sinusoidal testing done by Vestibulo-ocular reflex in both horizontal & Verical planes. The tests are separate tests when VNG equipment is used.

    As per this documentation we tried to bill CPT 92545 & 92546 for 2 units but Insurance has denied Billed quantity exceeds maximum number of services allowed.

    what we should do ? we already tried 76 modifier but not worked.

  7. #7
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Quote Originally Posted by anuja.devasthali View Post
    Same question here !

    Our provider is performing oscillating tracking test; with recording & Sinusoidal Vertical axis rotational testing.

    we are coding CPT 92545 & CPT 92546.

    We have a document stating we should code these procedures for 2 units as oscillating tracking done by smooth pursuits & saccades.The tests are separate tests when VNG equipment is used. Also Sinusoidal testing done by Vestibulo-ocular reflex in both horizontal & Verical planes. The tests are separate tests when VNG equipment is used.

    As per this documentation we tried to bill CPT 92545 & 92546 for 2 units but Insurance has denied Billed quantity exceeds maximum number of services allowed.

    what we should do ? we already tried 76 modifier but not worked.
    the 76 is incorrect as you have stated these are different test for different reason so you need to use the 59. The 76 states the exact same procedure repeated.

    Debra A. Mitchell, MSPH, CPC-H

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