Otolaryngology Coding Alert

Question: When my otolaryngologist sees a patient and the audiologist performs a subsequent hearing test, how should I report the services?

Texas Subscriber

Answer: In your case, you should report an E/M service appended with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) and the audiological test. For the otolaryn-gologist's history, examination and medical decision-making, which led to ordering the test, you should report the appropriate-level office visit (99201-99215, Office or other outpatient visit for a new or established patient) or outpatient consultation (99241-99245, Office consultation for a new or established patient ) appended with modifier -25 to indicate that the E/M is a significant, separately identifiable service from the audio. In addition, bill the code for the hearing test, such as 92552 (Pure tone audiometry [threshold]; air only). For Medicare, you must include a referring physician on the claim.

Modifier -25 is required in your example because the National Correct Coding Initiative (NCCI) bundles a minor E/M with codes that have XXX global days, such as the audiologic function tests (92551-92597). So, to bill an E/M in addition to a code containing XXX global days, the physician must perform more than what NCCI describes as "the inherent preprocedure, intraprocedure, and postprocedure work usually performed each time the procedure is completed."

In the case of audiology, the physician's E/M is usually inherently separate from the audiologist's testing. The otolaryngologist performs the E/M service, and the audiologist conducts the subsequent testing. Therefore, payers should not question that the physician performed a separately billable service. Some commercial insurers may not require modifier -25 on the E/M code, so you should ask payers for their guidelines.