Otolaryngology Coding Alert

Begin by defining what constitutes each component of service.

Similar to the world of otolaryngology coding, you’ll find plenty of rules, regulations, and guidelines pertaining to the audiology specialty if you know where to look. While there are numerous coding guidelines to consider, you’ll also want to brief yourself on what policies exist surrounding the billing of respective audiology services.

For instance, you’ve got to take more than a few different factors into account depending on who is furnishing and/or interpreting a given audiologic service.

Have a look at these sets of Centers for Medicare & Medicaid Services (CMS) policies within Chapter 12, Section 30.3 of the Medicare Claims Processing Manual to stay up-to-date on all the pertinent audiology billing rules and regulations.

Pinpoint Who Furnishes TC, PC Components

You should know when and where to divide audiology testing and interpretation into their respective technical and professional components. Contrary to some popular belief, you may bill out the audiology service with modifier 26 (Professional Component) and modifier TC (Technical Component) in any instance where the audiologist exclusively furnishes the professional component (PC). In these cases, you might see a physician or a nonphysician practitioner (NPP) furnish the technical component (TC) and the audiologist furnish the PC.

“There’s not much of an inherent difference when describing the TC and PC components from a radiological perspective or an audiology perspective,” states Lindsay Della Vella, COC, CMCS, medical coding auditor at Precision Healthcare Management in Media, Pennsylvania. “In audiology, the TC component involves the furnishing of the service. The PC component, on the other hand, involves the interpretation of the results of the service through a formal report,” explains Della Vella.

Know What to Do Barring Technician Involvement

However, things get a little trickier if and when you find an audiology technician added to the mix. In the instance that a technician furnishes the TC, the service is only deemed billable if the technician is directly supervised by a physician. If the technician is supervised by an NPP or audiologist, you should yield to the following guidelines:

• “Audiologists and NPPs may not bill for the TC of the service when a technician furnishes the service, even if the technician is supervised by the NPP or audiologist.”

This means that only physicians can bill globally when the physician supervises the technician-performed TC and performs the PC themselves. CMS further elaborates on the technicians allowed role involving audiology services:

• “Technicians shall not interpret audiology services, but may record objective test results of those services they may furnish under direct physician supervision.”

However, if you come across a case where a technician furnishes a service supervised by a physician, you’re not out of the clear yet. In these instances, CMS contractors will “review the technician’s qualifications to determine whether, under the unique circumstances of that test, a technician is qualified to furnish the test under the direct supervision of a physician.”

See Rules on Audiologists Furnishing Unrelated Services

Chapter 12 of the Medicare Claims Processing Manual offers some useful insights into the world of audiology coding and billing, but the buck doesn’t stop there. If you’re looking for even more guidance geared toward the audiology specialty, you should look no further than the MLN Matters article #MM6447.

There may be an instance where an audiologist performs a service that’s not found on the CMS list of audiology services. In these cases, CMS will still pay for the TC of diagnostic tests when the tests are furnished by audiologists as long as they are “under the designated level of physician supervision for the service and the audiologist is qualified to perform the service.” While these situations may not be commonplace, you should be aware of how to report them. Additionally, your audiologists and physicians should be aware that the possibility of billing out for such services exists as long as the guidelines are followed.

You can find a complete code list of audiology services here:  https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Audiology.html.