Otolaryngology Coding Alert

Medicare adds function test edits

It's official: You should no longer report 92552 or 92553 with 92563, thanks to version 9.3 of the National Correct Coding Initiative (NCCI).

The newest edits, effective Oct. 1, bundle 92552 and 92553 with 92563. Thus, if an audiologist performs 92552 or 92553 and 92563 (Tone decay test), you shouldn't report the pure tone audiometry (92552, Pure tone audiometry [threshold]; air only; or 92553, ... air and bone).

NCCI bases the edit on the most-extensive procedures. An audiologist would first perform the audiogram as an entry-level test for any hearing-related problem. If she suspects a retrocochlear disorder or central auditory processing deficit, she may progress to the tone decay test to determine the exact diagnosis. In this case, payers that follow NCCI will now include the audiogram in the tone decay test.

You may not use modifier -59 (Distinct procedural service) to unbundle the audiologic function tests edit. Medicare denoted a "0" (no modifier allowed) modifier indicator for the edit.