Otolaryngology Coding Alert

CPT know-how can sidestep potential compliance violations.

When it comes to OAE bundles, CCI isn't the only place you need to look.

An Audioeducator.com ENT attendee recently checked for edits on 92587 (Evoked otoacoustic emissions; limited [single stimulus level, either transient or distortion products]) and 92588 (... comprehensive or diagnostic evaluation [comparison of transient and/or distortion product otoacoustic emissions at multiple levels and frequencies]). "Can we bill for both of these codes on the same date of service if we have two different diagnoses for each code?" asks Kayla Chambers, billing supervisor at Ear, Nose and Throat Clinic of Coffee County and Westside Surgery Center in Douglas, Ga.

Look for Indentations on OAE Codes

If you plug the codes into Codify's CCI tool, you find that 92587 is a column 2 code for 92588. This bundle follows current procedural terminology (CPT).

Code 92588 is an indented code. Code 92587 is the parent code. To save space, CPT sometimes indents codes that still share the common definition of the previous code. Correct Procedural Terminology calls for you to report one code per family.

Translation: Both 92587 and 92588 share the common definition of "Evoked otoacoustic emissions." Code 92587 is a "limited" study and 92588 is a "comprehensive or diagnostic evaluation."

ID 92588's Relationship in 3 Steps

Analyzing indentations and code groups the following way will land you with the AMA created edits as shown in CPT.

Step 1: If you're using online code look up, check if the code you're looking at shares the beginning of its descriptor (the definition before the semicolon) with the previous or next code.

Step 2: Go to the first code in that group to have the shared entry and you've identified the parent code: in this case 92587.

Step 3: Think of each descending code as an evolved child who is more complex than the parent or base code. Code 92588 is part of the family and as it is in descending order, it is a more extensive code than the parent.

Here's another example, you wouldn't report unilateral mastoidectomy complete, modified radical, and radical. Codes 69505 (Mastoidectomy; modified radical) and 69511 (Mastoidectomy; radical) are indented under 69502 (Mastoidectomy; complete). You would report either the parent code (69502 for the complete mastoidectomy) or a more complex child code (69505 for a modified radical or 69511 for a radical mastoidectomy.

Check for OAE Modifier Allowance Using CCI

The only time you could report more than one code from the same code family is if modifier 59's (Distinct procedural service) definition applies. For instance, going back to the mastoidectomy scenario, if the ENT performed bilateral mastoidectomy (such as complete on the left and modified radical on the right), the procedure would qualify as a separate site thereby meeting a requirement for modifier 59. You could report both mastoidectomies using modifier 59 and if payer preferred or required the body side indicators as well. Your claim could include 69505-RT (Right side) and 69502-59-LT (Left side).

The CCI edits allow a modifier to differentiate between otoacoustic emissions (OAE) codes 92587 and 92588. If you bill 92587 with 92588 and no modifier, the contractor will deny 92587 as inclusive to 92588.

Error averted: Before you think modifier 59 is the shoe-in, kick around modifier 59's requirements as indicated in CPT's Appendix A "Modifiers": Documentation must support a different session, different site or organ system ..." When the audiologist provides both limited and comprehensive OAEs on the same date of service and documentation shows different diagnoses for each code, make sure modifier 59 on the component or parent code 92587 is appropriate under the circumstances.

Don't Use Modifier 59 to Unbundle OAEs

Let's think which modifier 59 criteria, two same day OAEs could fall under:

x Separate site: Codes 92587 and 92588 would not be allowed together for different ears because both codes are inherently bilateral. "All services include testing of both ears," according to the Audiologic Function Tests guidelines.

x Separate sessions: While having one OAE in the morning and another in the afternoon would not seem to be optimal for the patient, doing so would still result in coding only the more extensive procedure. For sake of argument, let's suppose an audiologist performs a single stimulus level in which she finds a hearing loss, the patient wants to come back after lunch for the more comprehensive evaluation. At the afternoon session, the audiologist compares the patient's loss at multiple levels and frequencies. Because the more conservative -- or screening code, turned into a more extensive or diagnostic evaluation, you would consider the limited study part of the comprehensive test and still report only 92588.

"There really should never be a circumstance to use modifier 59 with either 92587 or 92588," confirms Robert C. Fifer, PhD, Director of Audiology and Speech Language Pathology for the Mailman Center for Child Development at the University of Miami. "If an audiologist or physician starts with a 92587 procedure, realizes that more detail is needed, and switches to a 92588 procedure, then only 92588 should be reported for that date."

Bottom line: "Code 92588 is an extended, more comprehensive version of 92587," Fifer says. You should never report the two OAE codes together on the same date of service using modifier 59.

Author: Check out more advice from this article's author Jen Godreau, BA, CPC, CPEDC in "Simple Strategies to Boost Your ENT Ancillary Pay" and

other ENT speakers at http://www.audioeducator.com/cd-transcriptlist.php?s=213. Codify members save $25 on an audioconference of their choice for a limited time only.