Success story: Empire Medicare covers rhinometry thanks to this coder's digging You won't be hard-pressed to obtain acoustic rhinometry payment after one ENT coder reveals the documentation she used to overturn an insurer's view of the test as experimental. Allergists and ENTs are using this new diagnostic test to evaluate chronic rhinitis (472.0), writes David Plaxico, MD, with Allergy & Asthma Clinic of Macon in Georgia. -Have you seen much use of 92512 (Nasal function studies [e.g., rhinomanometry]) to date, and how useful is this in coding for this procedure?- he asks. Many insurers have policies that deem rhinometry experimental and investigational. For instance, Aetna won't cover 92512 in part because -clinical studies have not demonstrated that rhinomanometry and acoustic rhinometry improve clinical outcomes,- according to Aetna's -Clinical Policy Bulletin: Rhinomanometry and Acoustic Rhinometry- (visit www.aetna.com/cpb/ medical/data/700_799/0700.html). But showing payers a series of documents might make them change their tune.
Step 1: Show That 92512 Is FDA-Approved In the battle for 92512 coverage, expect insurers to first want evidence that the device is a Food and Drug Administration-approved product. Before covering 92512, Empire Blue Cross Blue Shield (Medicare Part B for New Jersey and New York state) required such proof, says Laura Colbert Carbonaro, CPC, director of central billing operations for ENT and Allergy Associates LLP in Tarrytown, N.Y. A phone call to the FDA resulted in a letter pointing Carbonaro to the documentation Empire BCBS required. -E. Benson Hood Lab Inc. received FDA marketing clearance on July 26, 2002, for their rhinoanemometer (FDA #K011329),- confirmed Bonnie J. Alderton, public health adviser at the FDA's Center for Devices and Radiological Health. Even better: Alderton identified the Web site of a copy of the clearance letter the FDA sent the firm upon clearing its device, which you can use in your fight. Find it at
www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?ID=4403.
Step 2: Tell the Payer What Rhinometry Is You can't hope to convince an insurer to cover a test if the representative has no clue what the device is. Solution: Provide a low-key explanation of rhinometry, such as this definition: -Acoustic rhinometry (AR) is a quick, painless, noninvasive, and reproducible method for examination of the nasal cavity using a sound pulse technique,- write the medical authors of -An Interpretation Method for Objective Assessment of Nasal Congestion With Acoustic Rhinometry- in Laryngoscope, 112: 926-929, 2002.
Step 3: Illustrate the Benefits of Rhinometry But Carbonaro didn't stop there. She also gathered information supporting the benefits of acoustic rhinometry in a ready-to-go package. To make an insurance representative reconsider his company's policy on 92512 being noncovered as investigational or experimental, point to the following scholarly article that demonstrates rhinometry's efficacy. An acoustic rhinometry study conducted by the [...]
