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Otolaryngology Coding Alert


Apply Incident-to Rules to Tech Audios

Question: Our three-ENT, two-audiologist office recently hired an audiology technician who will be doing testing and hearing-aid consultations. How should I bill Medicare for technician-performed testing?

Virginia Subscriber

Answer: You should bill the services incident-to the on-duty otolaryngologist if all incident-to criteria are met. Requirements include:

1. the technician or nonphysician practitioner (NPP) must be an employee

2. an otolaryngologist must provide direct personal supervision -- be on site in the office suite -- during the testing

3. the physician must order the tests so that the technician is providing the testing as part of a physician- initiated plan of care. Your question indicates that you have met the first requirement; if the testing meets the additional two, report the services incident-to.

Example: After an otolaryngologist examines a patient and orders comprehensive audiometry testing, an employed technician performs the testing. The physician is in the office suite throughout the testing. Because the scenario meets all three incident-to criteria, bill the testing incident-to the physician using 92557 (Comprehensive audiometry threshold evaluation and speech recognition [92553 and 92556 combined]).

Code the physician's work with the appropriate-level office visit service (such as 99203, Office or other outpatient visit for the evaluation and management of a new patient -). Some payers require modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) on the audio to show that the testing is significantly separate from the E/M service.

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Otolaryngology Coding Alert

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