Otolaryngology Coding Alert

The first nine codes (92601-92609) in the Evaluative and Therapeutic Services section describe services provided after a cochlear implant, including activating and programming the speech processor and aural rehabilitation. Codes 92601 and 92603 describe postoperative analysis and fitting of previously planted external devices, connection to the cochlear implant, and programming of the stimulator, according to the section's introduction. Codes 92602 and 92604 describe subsequent sessions for measurements and adjustment of the external transmitter and reprogramming of the internal stimulator.The new codes include:

Audiologists and speech-language pathologists perform most of the programming associated with cochlear implants, says Charles F. Koopmann, MD, MHSA, professor and associate chair of the department of otolaryngology , physician billing director, and a member of the faculty group practice at the University of Michigan in Ann Arbor, so the new codes will not impact otolaryn-gologists significantly.

To report evaluation and swallowing studies in 2002, otolaryngologists had to use, based on payer, either 92525 (Evaluation of swallowing and oral function for feeding) or one of two HCPCS level-two G codes, G0193 (Endo-scopic study of swallowing function [also fiberoptic endoscopic evaluation of swallowing] [FEES]) and G0194 (Sensory testing during endoscopic study of swallowing [add-on code] referred to as fiberoptic endoscopic evaluation of swallowing with sensory testing] [FEEST]). CPT 2003 deletes 92525 and instructs physicians and coders to see 92610-92611 in its place. Medicare has not announced whether it will accept these new codes and use them in place of G0193 and G0194.

One main change from 92525 to 92612-92613 is that the new codes break down the procedure and the evaluation, but the old code included the procedure and the interpretation, Koopmann says. So, if an otolaryn-gologist performs the procedure, you should report 92612. If he or she performs the interpretation and report only, assign 92613.

The AMA appears to be giving better descriptions for the swallowing tests, says Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J. Hopefully, Medicare and other payers will allow you to use these codes through their fee schedule.

If CMS approves work relative value units for these codes, the physician, not a speech pathologist, would have to perform the tests, Koopmann notes. For speech pathologist-provided services, payers may grant some practice expense, he speculates.

CPT 2003 includes an unlisted otorhinolaryngological procedure code (92700, Unlisted otorhinolaryngological service or procedure), which replaces deleted code 92599 (Unlisted otorhinolaryngological service or procedure). Coders who use 92599 to report the Epley maneuver or the canalith repositioning procedure (CRP) should now use 92700, Cobuzzi says.