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cpt 92557

Janice Posted Mon 02nd of April, 2012 13:31:28 PM

bcbs is dening this saying PATIENT HAS EXCEEDED THE AGE LIMIT FOR THIS SERVICE.
This is for an adult there is no age limit in the cpt book what other code woukd i use???

SuperCoder Answered Mon 02nd of April, 2012 21:46:58 PM

I do not see 92557 being denied on Age grounds. I agree there is no as such thing in CPT book. You should appeal for the claim that i can suggest.
If it would have medicare/medicaid the code V5010 describes a diagnostic audiological evaluation (similar to 92557). But V5010 also has a specific connotation of an evaluation that was performed for the primary purpose of selecting appropriate hearing aid amplification. Hence, if a patient were seen for a hearing evaluation to support an otolaryngology visit in the process of diagnosing hearing loss, then the audiologist would use the CPT code 92557. In contrast, if the patient were seen for the primary purpose of obtaining an audiogram for hearing aid selection, then the code V5010 would be appropriate. As a word of caution, there is sufficient overlap between the two codes that both 92557 and V5010 should not be used for the same visit. That may constitute double billing and cause difficulties down the road (i.e., audit).

There are other codes that are commonly used for audiological procedures for which no CPT codes exist or are generally not reimbursable by most third party payers. Examples include V5090 (hearing aid evaluation and fitting, monaural), V5110 (hearing aid evaluation and fitting, binaural), and V5900 (earmold). In the case of V5090, there is a corresponding CPT code (92590). But most commercial third party payers do not recognize this CPT code as a procedure eligible for reimbursement. For the other two examples, the CPT code 92599 (unlisted otolaryngological service or procedure) would be the only option. Obtaining reimbursement under 92599 is extremely challenging, at best! In general, the 'V' codes are used only with Medicare and Medicaid patients, and typically only Medicaid patients, since Medicare does not reimburse for any procedures related to hearing aids.

Meanwhile I will do more research, if i could get something more on this.

Janice Posted Tue 10th of April, 2012 17:47:16 PM

THANK-YOU SO MUCH

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