Otolaryngology Coding Alert

It's been a tumultuous nine months getting your office ready for Medicare's required direct reporting of qualified audiologists- diagnostic services.

These answers will help smooth some of the bumps still ahead.

You can easily identify eight possible codes that oto-techs may perform in Transmittal 84. "The technical components of certain audiological diagnostic tests i.e., tympanometry (92567) and vestibular function tests (e.g., 92541) that do not require the skills of an audiologist may be performed by a qualified technician or by an audiologist, physician, or nonphysician practitioner acting within their scope of practice." The transmittal specifies that technicians can perform certain audiological diagnostic tests that do not require the skills of an audiologist or physician while the patient is being tested to interpret the test results and respond, interpreting the future direction of the testing. The one test listed in the transmittal as meeting this requirement is tympanometry.

In addition, technicians can provide the technical portion of all vestibular function tests. The transmittal gives 92541 as an example of a code in that family. The full vestibular family is 92541-92546.

"i.e." is an abbreviation for the Latin words "id est" or "that is," according to Merriam-Webster's Dictionary.

The abbreviation "e.g." is Latin for "exempli gratia," which means "for example."

Transmittal 84 also states, "With the exception of screening tests and tympanograms, audiologic function tests with medical diagnostic evaluation require the skills of an audiologist." So you have 92567, plus screening codes 92551 and 92560, which Medicare does not cover.

Medicare's public files might give you a clue to additional codes, suggests the CMS official who authored Transmittal 84. "Refer to the technical components in the physician fee schedule practice expense and/or TC codes," the official tells Otolaryngology Coding Alert. In addition to vestibular codes (92541-92546), three additional audiological diagnostic codes (92585, 92587, and 92588) have technical components on the 2008 fee schedule.

In other words, under physician or qualified nonphysician practitioner supervision, a technician may be able to perform the technical component of 92567, 92541-92546, 92585, 92587, and 92588 provided the physician or NPP is responsible for all clinical judgment and for the appropriate provision of the service.

Final word: Check with your carrier, recommends the CMS official. "Some of the contractors have developed (or may be developing) policies that interpret the transmittals."

When an ENT provides an office visit for a patient and orders an audiological diagnostic test that a qualified audiologist in the same group performs on the same day, you should report the E/M and the test under each provider's NPI. "I have heard that the claims can be submitted on one form and that they should be on two," says Debbie Abel, AuD, director of reimbursement for the American Academy of Audiology. Each office should contact its Medicare contractor for this guidance, which may differ between MACs.

You-ll also have to check with your carrier for guid-ance on modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

Regardless of how many claims you have to use, CPT does not require modifier 25. The code's descriptor specifies "by the same physician." Because the physician is billing the E/M code and no audiologic procedures, "you wouldn't need the 25 modifier unless the ENT is billing for another non-audiology-related procedure," Abel says.

Problem: Because some contractors place a global on codes that contain "xxx" global surgical days, there may be contractors that will not pay for the E/M without modifier 25, points out Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J. Since it is obvious that the two different providers performed the E/M and the test, the claim(s) "should not need the 25, but that does not mean that the contractor will pay the E/M and audiology service properly, in particular, in this honeymoon period."

"It's already begun," Cobuzzi says, referring to BCBS of Iowa's July 2008 policy.

Wellmark will allow but not require audiologists to contract directly with Wellmark and bill under their own provider number. The policy gives this rationale: "Wellmark will have a more accurate representation of who is actually providing the services when audiologists bill under their own provider number."