Neurology & Pain Management Coding Alert

Question: During a recent audit, Medicare told us that we should not have billed multiple units of 92547 with electronystagmography (ENG) for year 2004. Is this correct? I can't find anything to back up this assertion.


Indiana Subscriber

Answer: Medicare is correct in this instance, but recent rule changes have widened your current options for reporting +92547 (Use of vertical electrodes [list separately in addition to code for primary procedure]).

In 2004, the American Medical Association asked that you report 92547 only once per visit because the code carried a relatively high value ($45.18) compared to its associated ENG codes (92541-92546). The point was that the AMA didn't think you should be reimbursed for 92547 more than once if you performed the full test battery.

In 2005, CMS decreased the fee for 92547, meaning that you may now bill this code multiple times--once for each test you perform with vertical electrodes (92541-92546). But the 2005 fee for 92547 is dramatically lower than the 2004 fee.

With a new fee of only $5.31 before geographical adjustments, you would receive only $31.86 even if you could report the code six times--more than $13 less than its 2004 value.

Reality check: In addition, you have no guarantee that a payer will automatically allow you to report this code for each test it applies to. Many payers have been unwilling to change their policy to consider multiple units of 92547, even with the drastic cut in fee.

If you run into objections, consider arguing to the payer that the high payment rate--which was the reason for the reporting limit--has been drastically slashed.