Pamela Posted Wed 14th of April, 2010 15:09:43 PM
I have ED physician who hass approached me about utilizing tympanometry in the ED. Upon further discussion and collective review of COPT coding options, the physician stated that the clinical indications for performing the Tympanometry is to determine the compliance or flexibility of the eardrum. This would be done in children and adults presenting with "head colds" , URIs, dizzy or deaf. This assists in the differential diagnosis of Serous and Otitis medias. The tympanometry can be performed by a nurse or doctor and the measurement documented as are vital signs. According to the physician this is not screening as in hearing or audiologcal (92551) as originally though, but rather 92567 Tympanometry (impedance testing).
1. If done in the ED , would this be an additional service in addition to the ED E&M as technical component if done by Nurse? or professional if done by Dr? or at all - is it part of the "evaluation" I see no excludes or includes not as to its use with the ED E&Ms.
2. Is documenting the resulting pressure ( of both ears) as well as the physicians ED diagnosis sufficient for recording results and interpretation?
4. This code appears to have APC reimbursement - not sure of fee schedule implications for other payers.
Thanks for any help or guidance!
SuperCoder Answered Thu 15th of April, 2010 10:03:21 AM
1) You can bill an E/M service along with coding 92567, performed on the same day, provided the physician has documented the E/M service separately and as a significant & separate service. But this service cannot be split into PC (26)/TC components.
To bill an E/M in addition to tympanometry (92567, Tympanometry [impedance testing]), insurers will probably require that the office visit constitute a separately identifiable service from the tympanometry.
Many private payers follow Medicare’s policy and require modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) appended to E/M codes to indicate that on the day a procedure or service was performed, the patient’s condition required a significant, separately identifiable E/M service above and beyond other services provided or beyond the usual preservice and postservice care associated with the performed procedure.
Example: An established patient with serous otitis media comes in for a follow-up visit. The pediatrician performs a low-level E/M (99212, Office or outpatient visit for the E/M of an established patient …) but is unsure if the child’s condition has cleared and therefore performs a tympanogram (92567). You should report the office visit (99212) appended with modifier 25 to indicate that the exam is a significant and separately identifiable service because it led to the decision to perform the test. Link 99212-25 and 92567 to the serous otitis diagnosis code (381.10, Chronic serous otitis media, simple or unspecified).
For a new patient, the service is clearly separate. For example, a new patient whom another physician already diagnosed with serous otitis media presents to a pediatrician who believes the child may have hearing loss and performs impedance testing (92567) to determine if the eustachian tube is functioning normally. The results are negative. Therefore, you should use the serous otitis ICD-9 code for both services, with modifier 25 attached to the appropriate level of E/M.And the code 92567 would be a separate entry, of course.
Medicare's Transmittal about audiology diagnostics specifies that technicians can perform Tympanometry test 92567) that do not require the skills of an audiologist or physician while the patient is being tested to interpret the test results and interpreting the future direction of the testing, provided the physician or NPP is responsible for all clinical judgment and for the appropriate provision of the service.
2) As for the question no. 2, these specifics that you have mentioned should serve the purpose.
3) For fee schedule implications of various payers, you can consult the SuperCoder Fee Schedule tool at --