Otolaryngology Coding Alert

Audiologists use VRA, CPA for patients who can't participate in threshold tests

Once you have the -411- on what visual reinforcement audiometry (VRA) and conditioning play audiometry (CPA) are, nonpublished threshold bundles will make more sense to you, resulting in faster coding.

Discover the Subjects of 7 Audio Tests

You-re probably in the habit of looking to the Correct Coding Initiative (CCI) as your guide to properly reporting code combinations. But when it comes to reporting seven audiometry codes, you need to understand what the tests are to understand why certain combinations are mutually exclusive -- quot;  and why you should never bill them together. Get the scoop on these tests:

Pure tone audiometry: This threshold test uses pure tone to indicate a patient's range of hearing. Classify this test to 92552 (Pure tone audiometry [threshold]; air only) or 92553 (- air and bone).

Speech: Speech audiometry tests (92555, Speech audiometry threshold; and 92556 ... with speech recognition) use spoken words and sentences rather than pure tones.

Comprehensive: When the audiologist performs both pure tone tests and speech recognition, code the comprehensive audiometry threshold with 92557 (Comprehensive audiometry threshold evaluation and speech recognition [92553 and 92556 combined]).

CPA: In conditioning play audiometry, the child learns to perform a certain task (for example, place a block in a box) when she hears a certain sound. CPA requires a conditioned response. -We usually perform this test on children from 2-1/2 to 3 years old to about 5 years old,- says Gerard A. McCall, MA, CCC-A & SP, audiologist at Eastern ENT Sinus and Allergy Center PA in Goldsboro, N.C. Report CPA with 92582 (Conditioning play audiometry).

VRA: Audiologists typically provide visual reinforcement audiometry (VRA) for young children, usually those with an age -between 4 months and 36 months,- McCall says. The child indicates a -positive- response -by repeatable orienting responses,- he says.

During the test, the child wears earphones or sits between speakers. When the patient hears a tone, he turns toward the source with a head turn or eye rotation. You should code VRA with 92579 (Visual reinforcement audiometry [VRA]).

Edit 1: Realize CPA/VRA Replaces 92557

Although no published edit bundles comprehensive audiometric testing (92557) with conditioning play audiometry (92582), you shouldn't report this combination. Why? -CPA and VRA are substitutes for 92557,- says Mark Kander, director of healthcare regulatory analysis at the American Speech-Language-Hearing Association in Rockville, Md.

When a patient cannot participate in a threshold exam, he may instead undergo CPA or VRA. -We use VRA for children below age 2-1/2 to 3 years old and find it to be efficient and reliable, though not as reliable as threshold,-  McCall says.

Edit 2: Opt for Either 92552 or 92579

You also shouldn't report VRA with audio A/C threshold (92552). Why? Codes 92552 and 92579 measure the same hearing, Kander says. If a patient can participate in pure tone audiometry, VRA wouldn't be necessary, he says.

-On occasion, our audiologists run across patients who cannot do the pure tone tests,- says Karen Strickler, office manager at The Ear Center of Greensboro PA in North Carolina. Here's how a pure tone test differs from VRA:

-In the pure tone audiometry threshold test, the patient wears headphones and repeats back to the audiologist a list of words,- says Amy Daughton, MEd, CCC-A, audiologist at The Ear Center of Greensboro. This is how the audiologist registers the patient's response.

In the VRA the audiologist uses speakers in the booth. When the patient hears the sound and turns to that speaker, the audiologist makes an animated toy perform. Each time the patient turns to the correct sound, a toy will be turned on to reinforce the patient's continued response.

Bottom line: -If the patient can repeat the words back to the audiologist, there would be no need to try to get a response any other way,- Daughton says.

Edit 3: Report Speech Threshold or VRA

Has your audiologist told you not to code a speech threshold in addition to VRA? If you look in the CCI, you won't see 92579 and 92555 bundled, says Kim West, business office coordinator at Virginia ENT Associates in Richmond.

Surprise: No edit doesn't mean VRA (92579) and speech threshold (92555) are a valid combo. VRA is a substitute for speech threshold. -Code 92555 can't be paired with VRA simply because speech threshold 92555 is a subpart of speech recognition 92556, and 92556 is a component of comprehensive audiometric testing 92557,- Kander says. If a patient can participate in speech threshold by repeating words and sentences, there would be no need to perform VRA.