Neurology & Pain Management Coding Alert

You could be losing more than $100 if you don't know how to report multiple studies

As many neurology practices are just now delving into auditory evoked potentials testing, learning how to properly report these services can throw billing offices off-balance. Review our expert responses to your common questions, and steer clear of trouble spots.

Question 1: What is the difference between a comprehensive and limited auditory evoked response exam?

Before 2001, you had only one option for reporting evoked response audiometry. CPT 2001, however, revised code 92585 (Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive) to clarify its use for comprehensive exams. Similarly, 92586 (... limited) was added to define limited AEP testing.

But confusion still persists about what constitutes the difference between the two code categories. -A lot of people in the field are still struggling to answer this question,- says John Finkbeiner, resource coordinator for the Neurological Testing Center at Northwestern Memorial Hospital in Chicago.

Helpful: To distinguish between the two, you can look at the number of levels performed--with a comprehensive study requiring three intensity levels per ear, and a limited exam involving one to two levels.

-The comprehensive AER exam includes middle latency and late cortical responses, as well as evaluation of brainstem response,- says Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine.

-By combining these three types of auditory EPs, the status of several areas of the central auditory nervous system--including auditory periphery and brainstem; pathways between midbrain, thalamus, and auditory receptive area of each temporal lobe; and multiple generator sites throughout the cortex--is evaluated,- Busis says.

Rule of thumb: One simple guideline that can help differentiate between comprehensive and limited studies is to look at the age of the patient. While it's not a hard and fast rule, a neurologist will primarily perform a limited audiometry examination involving one or two intensity levels for infant screening evaluations. Adult patients will more frequently receive a comprehensive exam.

For comprehensive testing, neurologists will -look for localization of different structures, but [with infant screenings], they-re just going to see if the structure is intact,- Finkbeiner says.

Question 2: What requirements do I need to meet to claim the global fee for AEP exams?

The global fee for comprehensive audiometry includes recording, physician interpretation and report. You can only report the global for 92585 if your neurologist--or a technician under his employ--completes all three of these elements.

In contrast, you must append modifier 26 (Professional component) under these three circumstances:

 - The neurologist provides interpretation only,
 - The neurologist does not use his own equipment, or
 - The auditory study is administered in a hospital.

Remember: For many payers, including Medicare, you need to append modifier 26 for any service performed in a hospital setting (place of service 21). Reason: Payers that use a group-based payment system automatically provide reimbursement for technical components to the hospital directly.

That means that even if the physician brings his own equipment to the hospital, performs the test (or hires the technician), -he can only bill Medicare a 26 in site of service 21,- says Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting, a reimbursement consulting firm in Denver.

Exception: You don't need to worry about attaching modifier 26 to 92586 because the physician fee schedule does not break that code into technical and professional components. Your only option is to report the global service without appending any modifiers.

Question 3: If I perform multiple types of exams, is it possible to report multiple units of 92585?

If your practice has a physician specializing in otoneurology, you may come across circumstances when a single comprehensive study is not adequate. You can report multiple AEP test types during a single session, but how you code your services and your chances for reimbursement can vary greatly depending on your payer.

Example: To determine frequency-specific testing results for a patient, the neurologist performs two comprehensive AEP tests, click auditory brain response (ABR), and tone burst ABR. Each of these tests on its own could justify reporting of 92585, so how can you recoup payment when you perform two or more of these exams in a single session?

Option 1: Your solution can be as simple as using the units field on your claim to record 92585 x 2. But depending on your payer, you may come up against a denial for multiple units.

Option 2: Your best bet for reimbursement may lie in using modifier 22 (Unusual procedural services). Although 92585 is not a time-based code, time can be a good marker for establishing an unusually long evaluation. For example, tone burst ABR can take as much time as performing conventional ABR in each ear.

Fair warning: For many payers, modifier 22 automatically prompts review of individual claims, so you need to make sure that you have the documentation to back up your coding.

Providing a justification letter that describes the medical necessity for multiple testing along with precise documentation of the time involved can help to ward off denials and secure deserved reimbursement.