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 [...]