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Otolaryngology Coding Alert

Debunk 5 Myths of Coding for Audiological Tests

Reimbursement matches MD's when audiologist bills 92552-92557 and more

Don't let incident-to and diagnostic service guidelines muddy the waters when coding for audiologist-performed hearing and vestibular services. You could be making claims blind using incident-to instead of giving the audiologist due credit. Have Audiologists Use Own Numbers Myth #1: The first myth you have to debunk goes something like this: You have to know the ins and outs of incident-to when billing audiology services. Reality: You can forget these details.

Why: Diagnostic audiological services have earned their own benefit category from CMS, says Kadyn Williams, AuD, chair of the American Academy of Audiology (AAA) coding and reimbursement committee. That means, -technically, diagnostic audiology services by an audiologist should never be billed incident-to.-

Instead: You should report an audiologist's services using his own provider identification number (PIN)/unique physician identification number (UPIN) or, as of May 23, 2007, his own national provider identifier (NPI). -Audiologists are professionally able to bill independently and should be billing that way,- says Williams, who is also co-director of Audiological Consultants of Atlanta. Check for Qualifying Codes Myth #2: Billing independently opens all the codes on your otolaryngology practice's super bill to your audiologist. Not true. 

Reality: -Audiologists are able to bill diagnostic codes but are prohibited from billing Medicare for treatment codes,- according to Paul Pessis, AuD, in his audio conference -Code Blue: More on Reimbursement.- For instance, an audiologist cannot bill cerumen removal (69210, Removal impacted cerumen [separate procedure], one or both ears) to Medicare, -- because CPT code 69210 is a treatment code.-

But specific regulations apply to diagnostic codes. -Hearing and vestibular procedures have their own separate benefit category as -other diagnostic tests,- - says Lisa Miller Jones, MS, director of reimbursement for the AAA in Reston, Va.

Tip: You can easily identify diagnostic test codes by looking at column -AF- of the 2007 Medicare Physician Fee Schedule. A designation of -5- indicates -Physician supervision policy does not apply when procedure is furnished by a qualified audiologist; otherwise must be performed under the general supervision of a physician.-

Diagnostic testing codes include hearing and balance services. Applicable codes include:

- audiologic tests from 92552 to 92557; 92561-92584.
- the technical portion (modifier TC) of vestibular function tests 92541-92546 and 92548. For a full list of these codes, see box below.
Expect Same Payment for AuD Billing Myth #3: Your office manager worries that billing for diagnostic tests under your audiologist's number will mean less money. Set her straight.

Nonphysician practitioners (NPPs) who are unable to bill Medicare independently for their services  are subjected to a payment reduction. -However, audiologists are able to bill  Medicare as independent practitioners and therefore receive 100 percent of the Medicare Physician Fee Schedule  payment,- Jones says.

Note: The February [...]

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