Otolaryngology Coding Alert

Get paid for component services

If you're not taking advantage of modifiers -TC and -26 for certain audiology codes, you could be forfeiting pay for your otolaryngologist's hearing-test services.

General and higher-level audiology codes including vestibular function tests (92541-92546, 92548), auditory brainstem response audiometry (92585, Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive), and evoked otoacoustic emissions (OAE, 92587-92588) contain a professional component (modifier -26, Professional component, for physician interpretation) and a technical component (modifier -TC for equipment, supplies and audiologist), says Eileen M. Giaimo, MEd, CPC, director of economic affairs with the American Academy of Otolaryngology Head and Neck Surgery. So, the services your otolaryngologist provides and where the audiologist performs the testing affect your audiology coding. If your otolaryngologist provides the professional and technical component, you should report the global code, she says. But when your practice doesn't employ audiologists or your otolaryngologist doesn't provide separate documentation, you need to designate what services you're billing for.

To improve your reimbursement, coding experts recommend that you report audiology services based on these three guidelines:

1. Use Global for In-Office Audiology With Report

When your otolaryngologist employs audiologists and owns the equipment, you should use the global code if he issues separate documentation, says Kim Pollock, RN, MBA, an otolaryngology coding speaker and consultant with KarenZupko & Associates in California. You should give your otolaryngologist credit for the physician interpretation when he writes a report similar to a radiologist's or notes his findings on the audiologist's interpretation. "Don't count a check mark or note that states 'agree' as an interpretation," instructs Pollock, who presented on audiology coding at the Association of Otolaryngology Administrators' 21st Annual Educational Conference in Orlando, Fla.
 
Encourage your otolaryngologist to show that he reviewed the test results. For instance, after an audiologist performs an in-office electronystagmography (ENG) (92541-92545), the otolaryngologist notes why he agrees or disagrees with the reduced vestibular response. In this scenario, the otolaryngologist owns the equipment, employs the audiologist, and documents a separate interpretation from the audiologist. So, you should report the global code, such as 92541 (Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording), Pollock says.

2. Assign Modifier -TC for Testing Only

If your otolaryngologist doesn't issue a report, you should use modifier -TC to indicate that you are coding for your audiologist's services only, says an otolaryngology administrator in Miami. Suppose in the above example the otolaryngologist marks "agree" on the audiologist's interpretation. You should report 92541-TC to indicate that you are claiming the audiologist's services and equipment expense only, she says.

3. Apply Modifier -26 to Outside Testing

Just because your practice sends patients off-site for audiology testing doesn't mean you have to forfeit all reimbursement. You may code for the interpretation with modifier -26 if no other physician performs this service, Pollock says.
 
For instance, an otolaryngologist sends a patient to a hospital's audiology department for a comprehensive auditory evoked potentials response test (92585). The otolaryngologist writes a separate report describing why he agrees with the audiologist's interpretation. To bill for the professional component, you should append modifier  -26 to 92585, while the hospital assigns 92585-TC.
 
If you use an independent audiologist, here's how to get reimbursed for the professional component: Your otolaryngologist sends a patient for an ENG (92542) and documents his test review. To get the $18.40 for the professional interpretation, you should append modifier -26 to 92542. The independent audiologist bills 92542-TC.  Watch out: Before you start billing outside audiology services the above way, check with the facility to make sure no other physician is performing the interpretation, Pollock says.