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Otolaryngology Coding Alert

Reader Questions:

Before Coding Replacement, Check POS

Question: What code should we use for replacing a Blom-Singer prosthesis?

Wyoming Subscriber
Answer: You may report replacing the voice prosthesis with 92597 (Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech). Check with Medicare carriers about rules for using 92597, which has -A- (Active) status, according to the Medicare Physician Fee Schedule.

But Medicare considers this code, which speech language pathologists often bill, part of the speech therapy services that coders must consolidate in a patient's Part A skilled nursing facility or Part B SNF stay. Therefore, Medicare will not allow payment for 92597 when performed in a skilled nursing facility (place of service 31) or nursing facility (POS 32). But the service is payable in the office (POS 11).

Be careful: Bill the prosthesis to your durable medical equipment regional carrier (DMERC), not your Medicare Part B carrier. When the provider inserts a new prosthesis, report the supply with HCPCS code L8509 (Tracheoesophageal voice prosthesis, inserted by a licensed healthcare provider, any type). Patients can purchase and insert the device described in L8507 (Tracheoesophageal voice prosthesis, patient inserted, any type, each).

Warning: Do not separately code for the initial placement of the voice prosthesis. This service is included in the charge for the original surgical procedure (31611, Construction of tracheoesophageal fistula and subsequent insertion of an alaryngeal speech prosthesis [e.g., voice button, Blom-Singer prosthesis]).  

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