Otolaryngology Coding Alert

Codes 92543, 92547 permit multiple billings; 92542, 92545 don't

You can avoid losing $40 in electrodes services if you know the new way to report 92547, as well as how many units certain electronystagmography (ENG) tests allow.
 
With some ENG tests taking one unit and others allowing multiple units, otolaryngology coders have a hard time keeping 92541-92547's billing rules straight.

Bill 92542 Only Once

Even though a positional nystagmus test involves multiple positions, you should code per test, not per position. Since CPT's 92542 descriptor states, "Positional nystagmus test, minimum of four positions, with recording," you should never bill 92542 as more than one unit, says Laura Colbert Carbonaro, director of central billing operations for ENT and Allergy Associates, which serves 57 physicians and 30 licensed audiologists in New York and New Jersey.
 
Tip: If the test involves fewer than four positions, you may report 92542 with modifier -52 (Reduced services), says Debbie Abel, AuD, audiologist at Northern Arizona Speech and Hearing Center in Sedona, Ariz., and owner of Alliance Audiology in Alliance, Ohio. Positions may include supine with the head extended dorsally, left and right; and sitting.

Report 92543 per Irrigation

You may, however, bill multiple units of 92543 (Caloric vestibular test, each irrigation [binaural, bithermal stimulation constitutes four tests], with recording). In this test, the audiologist irrigates the ear with warm and then cold water. If she performs the irrigation on each side (binaural) with duel temperatures (bithermal), she does four irrigations: right ear - warm, cold; left ear - warm, cold. "Code 92543 is per irrigation, so up to four units is appropriate," Carbonaro says.
 
Code Single Tracking Test

When an audiologist performs an oscillating tracking test (92545, Oscillating tracking test, with recording), you should also limit the units to one. "Code 92545 does not really lend itself to multiples," says Phyllis Schaffer-Cohen, AuD, FAAA, director of audiology at ENT and Allergy Associates in Tarrytown, N.Y.
 
Why?: In 92545, the audiologist asks the patient to move only his eyes. "We are not doing anything in this case but instructing, while the patient stays in one spot,"  Cohen says.

Add-on Electrode Code per Test

Despite contradictory advice on the vertical electrode add-on code, you may use multiple units with +92547 (Use of vertical electrodes [list separately in addition to code for primary procedure]). You can bill 92547 up to eight times with 92541-92546, Schaffer-Cohen says. Coding 92547 x 8 implies that the audiologist performs "eight tests that lend themselves to vertical electrode recording."
 
Why you may hear differently: CPT considered 92547 a per-day code, the AMA explains in CPT Assistant February 2005. "Because the code's descriptor states 'electrodes' plural, prior to 2005, we billed 92547" once per date of service, says Jessica Loyd, billing manager at ENT Center in Denver.
 
Problem: In 2005, Medicare and other payers valued the service on a per-test basis. "Code 92547's relative value units (RVU) decreased about 90 percent this year," Loyd says. The electrode service code now contains 0.14 RVUs ($5.30 nationally), down from 1.21 RVUs ($45.86 unadjusted). Therefore, CPT agreed "it would be appropriate to report code 92547 in addition to the code(s) for the primary procedure(s) for each vestibular test performed."
 
Editor's note: For a complete list of ENG codes with unit allowances, see the clip-and-save guide below.