Otolaryngology Coding Alert

4 guidelines get you the right diagnostic or rehab code

If you're not coding for assessment, reassessment and aural rehabilitation of cochlear implant patients, you could be sacrificing deserved dollars.
 
Even though 69930 (Cochlear device implantation, with or without mastoidectomy) contains a 90-day global period, diagnostic and aural rehabilitation are not included in the follow-up care allowance. So, you should separately report these services using these guidelines:

1. Use 92601-92604 for Medicare Diagnostic Analysis

When a patient receives a cochlear implant, the audiologist must initially program the speech-generating device and then periodically adjust it. HGSA, Pennsylvania's Part B Medicare carrier, pays from $142 for programming to $63 for tune-ups, if you use CPT's evaluative and therapeutic services codes.
 
In 2003, CPT introduced four age-based codes for cochlear implant programming and reprogramming.    When your audiologist provides diagnostic analysis for a patient who is younger than 7 years old, you should report 92601 (Diagnostic analysis of cochlear implant, patient under 7 years of age; with programming) for the initial stimulation and 92602 (... subsequent reprogramming) for the follow-up programming, says Amy H. Nunnelee, MA, CCC-A, clinical audiology instructor at the University of Kansas Medical Center in Kansas City. "For patients age 7 or older, you should bill 92603 (Diagnostic analysis of cochlear implant, patient 7 years of age or older; with programming) for initial stimulation and 92604 (... subsequent reprogramming) for follow-up programming."
 
Diagnostic analysis services usually occur at the following frequency shown in the chart.
 
So, possible coding for an adult Medicare cochlear implant patient using the above schedule could generate more than $1,200 in audiology revenue. That's based on geographically adjusted Medicare rates for Pennsylvania. For instance, an audiologist in Philadelphia provides the following diagnostic services:
 Initial programming (92603):                          $94.58
 15 tune-ups (92604) in year 1: $63.59 x 15 = $953.85
 3 tune-ups (92604) in year 2, 3: $63.59 x 3 = $190.77
 Total HGSA participating amount:              $1,239.20

2. Follow Other Payers' Billing Requirements

Check with non-Medicare insurers for coding policies. Some payers require you to use the "old" CPT code for aural rehabilitation with or without programming, 92510 (Aural rehabilitation following cochlear implant [includes evaluation of aural rehabilitation status and hearing, therapeutic services] with or without speech processor programming).
 
For instance, Kansas Medicaid doesn't have 92601-92604 in its system. "So, we still bill 92510 for programming," Nunnelee says.

3. Assign 92507-92508 for Rehab

After receiving a cochlear implant, the patient also has to go through aural rehabilitation. During this process, an audiologist or speech pathologist helps the patient communicate better and improve his or her speech and language skills, says Steven C. White, PhD, the healthcare economics and advocacy director at the American Speech-Language-Hearing Association in Rockville, Md.
 
When an audiologist or speech pathologist provides only aural rehabilitation, select the code based on the number of patients in the therapy session. For individual therapy, you should report 92507 (Treatment of speech, language, voice, communication, and/or auditory processing disorder [includes aural rehabilitation]; individual), White says. If therapy involves two or more patients, you should use 92508 (... group, two or more individuals).

4. Know the Same-Day Treatment Limits

Coding becomes more complicated when an audiologist programs or tunes up the implant and also provides aural rehabilitation. "Some payers may allow 92510 for aural rehabilitation following cochlear implant, but Medicare does not," White says.
 
For Medicare, you can only report the diagnostic service. The National Correct Coding Initiative bundles 92507-92508 (rehab) with 92601-92604 (diagnostic). Even though programming and rehab are different services, NCCI says that you can't split the billing, Nunnelee says.