Otolaryngology Coding Alert

Here's the rationale behind ENG test unit rules.

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. Break down each code, and you'll be applying the correct number of units to your claims in no time.

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 Carbonaro, director of central billing operations with ENT and Allergy Associates, LLP, with offices 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, director of reimbursement for the American Academy of Audiology in Reston, Va., 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, experts say.

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

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. Coding 92547 x 8 implies that the audiologist performs eight tests that lend themselves to vertical electrode recording.

Why you may hear differently: Make sure your coding guides are up to date.

Five years ago, CPT considered 92547 a per-day code, the AMA explained in CPT Assistant February 2005. Because the code's descriptor states "electrodes" plural, prior to 2005, coders billed 92547 once per date of service.

Editor's note: For a complete list of ENG codes with unit allowances, see below clip-and-save guide, "Not Every ENG Test Code Permits Multiple Reporting."