Otolaryngology Coding Alert

Think using the same codes for professional-performed and computer-administered audiological testing doesn't seem fair? CPT is on your side.

The AMA recently used administration to delineate coding audiologic function tests 92557 (Comprehensive audiometry threshold evaluation and speech recognition [92553 and 92556 combined]), 92567 (Tympanometry [impedance testing]), 92568 (Acoustic reflex testing; threshold) and 92587 (Evoked otoacoustic emissions; limited [single stimulus level, either transient or distortion products]). Make sure you keep your coding on the straight and narrow with this expert advice.

Before you file another claim for 92557, 92567, 92568 and 92587, check that the tests meet this criterion: an audiologist or other qualified healthcare provider administers them. Reporting these codes would be inappropriate "if they are performed by a computer instead of a healthcare professional," according to the September 2007 CPT Assistant question and answer "Medicine: Special Otorhinolaryngological Services."

The AMA bases its stipulation on the audiological test code's relative value units (RVUs). "The current codes (92557, 92567, 92568, etc.) are valued on the personal delivery of services by a professional," says Robert C. Fifer, PhD, associate professor and director of audiology and speech pathology at the University of Miami's Mailman Center for Child Development.

An audiologist or other qualified healthcare provider administers the automated tests (that is, otoacoustic emissions, ABR, tympanometry). The healthcare professional "oversees the results to ensure accuracy of outcomes and ensures that the findings are in clinical agreement with other test outcomes," Fifer says.

New technology opened the door to potential misuse of 92557, 92567, 92568 and 92587. These codes- descriptors and valuations "do not take into account automated administration of these tests," Fifer says.

Using the traditional codes for automated tests overcompensates you by paying you for non-performed work. "Computer-administered tests, such as the Otogram, do not rely on the administration and oversight of a professional to determine the outcome," Fifer says.

Instead: After the patient has the earphones placed and some introductory instructions, these tests can be self-administered, the Otogram Web site says. The computer administers each test, automatically determines the accuracy of the outcome, scores the results where scoring is necessary, and prints the results in a written output.

"Our physicians and audiologists were concerned with the reliability of patient-performed tests," says Janet Agemian, CPC, revenue cycle manager at Associates in Ear, Nose, Throat & Facial Plastic Surgery PA in Woodbury, N.J. What would the patient do if she had a problem?

To avoid overcharging for a computer-administered test, you-ll have to use 92700 (Unlisted otorhinolaryngological service or procedure). "At the present time, there are no codes for providing completely automated procedures that do not include a professional performing the diagnostic procedures," the AMA says. Therefore, the appropriate code to report is 92700.

Using separate codes based on administration makes sense, Agemian says. "The computer-administered test doesn't require the expertise to operate."

When reporting an unlisted-procedure code, expect the payer to manually review the claim. You will need to justify the test. Fifer says to include these items:

- why the procedure was done

- what equipment was involved

- what was the "work" involved

- what was the outcome

- what diagnostic or therapeutic benefit the procedure provided for the patient.

Time saver: If have an automated system, create a template form letter so you won't have to re-create the wheel each time you submit 92700 for a computer-administered test.