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Can you bill different fees for HCPCS V5256?

SuperCoder Posted Wed 29th of February, 2012 13:18:41 PM

I am not very familiar on how to bill for 'audiology' claims. I have a question on how to bill HCPCS code 'V5256' Hearing aid, digital, monaural, ite.
The Audiologist wants to bill different fees depending on the model of hearing aid.
Is it ok to bill different fees for the same HCPCS code?
Do we need to document the model on the claim?
Any advice on billing this code would be appreciated.

SuperCoder Answered Wed 29th of February, 2012 20:19:21 PM

Published in Otolaryngology Coding Alert, June 2004

Experts reveal V code secrets

Think your hearing-services coding begins and ends with 99070? You can expand your options and specificity with V codes.

Ignoring these supply codes could cost you payment. But many coders don’t know that HCPCS offers an array of specific hearing aid codes that many Medicaid programs and private insurers accept.

Audiology experts offer the lowdown on using these 60-plus codes in your otolaryngology practice.

HCPCS Provides Supply Specificity

Whenever CPT doesn’t define a service, you should look to the HCPCS manual for a code. Often, HCPCS contains codes for supplies or offers more specificity than CPT does, says Debbie Abel, AuD, chair of the American Academy of Audiology’s Coding and Practice Management Committee.

Example: Your audiologist sells a monaural, in-ear hearing aid to a 5-year-old boy. The only option CPT offers is 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]), a catch-all supply code.

Better way: You should choose HCPCS supply code V5050 (Hearing aid, monaural, in the ear) instead. The HCPCS code is more specific, Abel says.

These 6 Codes Capture More Hearing Services

You should also use HCPCS codes when your audiologist performs several hearing aid-related services.

Your audiologist may provide initial services such as a hearing screening and a hearing aid assessment. HCPCS defines these services with V5008 (Hearing screening) and V5010 (Assessment for hearing aid).

When the audiologist initially fits the hearing aid, you may charge a dispensing fee. Submit V5241 (Dispensing fee, monaural hearing aid, any type) for monaural hearing aid dispensing, and V5160 (Dispensing fee, binaural) for binaural dispensing, says Amy H. Nunnelee, MA, CCC-A, clinical audiology instructor at the University of Kansas Medical Center in Kansas City.

Caution: Insurers may bundle the initial adjustment into V5241 and V5160. In this case, you shouldn’t charge for the adjustment, Nunnelee says.

Some payers may also include subsequent adjustments in V5241 and V5160’s global surgical period. Check your top insurers’hearing service V code inclusions, because you can’t use Medicare as a guide.

Although Medicare designates hearing services with “xxx” global days, the government doesn’t cover these services. Medicaid and other insurers that accept V codes may implement individual coding guidelines.

If your patient’s visit does not fall under a global period, you should code any hearing aid checks or repairs. Report a hearing aid fitting or check with V5011 (Fitting/orientation/checking of hearing aid), Abel says. When the audiologist repairs a hearing aid, use V5014 (Repair/modification of a hearing aid).

3 Steps Get You the Right Hearing Aid V Code

Don’t think you can accurately identify hearing supplies? HCPCS contains more than 30 specific hearing aid codes.

Use the hearing aid’s description to find the right V code. You’ll need several pieces of information to track down the right supply code.

For instance, you should know the hearing aid’s location. Is it an in-the-ear (ITH) model (like V5130, Binaural, in the ear) or a behind-the-ear model (BTE) (such as V5140, Binaural, behind the ear)?

Determine whether the audiologist prescribes one (monaural) or two (binaural) hearing aids. Possible codes include V5050 (Hearing aid, monaural, in the ear) and V5060 (Hearing aid, monaural, behind the ear).

Finally, look at the hearing aid type, such as digitally programmable analog (for example V5247, Hearing aid, digitally programmable analog, monaural, BTE [behind the ear]) or digital (as in V5256, Hearing aid, digital, monaural, ITE).

Tip: Check whether the hearing aid box contains HCPCS coding instruction. If not, Minnesota Medicaid published a handy list of hearing aid model numbers with corresponding V codes.
Here’s how the guide works: Your audiologist prescribes a Phonak 9100 Astro SC. You locate the model number under “ITE digitally programmable.” The chart directs you to V5246 (Hearing aid, digitally programmable analog, monaural ITE [in the ear]) or V5252 (Hearing aid, digitally programmable, binaural, ITE). You check that the patient requires two hearing aids, so you submit V5252.

Most Payers Recognize Hearing-Related V Codes

Before using HCPCS codes, check payer recognition and coverage.

Good news: Most insurers accept the V codes, Abel says. Even though Medicaid coverage varies by state, many programs list the V codes as valid submission codes.

To get details on state hearing-related coverage, visit www.hearingloss.org/html/medicaid_by_state1.HTM. If a payer doesn’t accept the V codes, try CPT’s general supply code 99070

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