Otolaryngology Coding Alert

Question: When an audiologist uses electroneurography (ENG) to record caloric vestibular testing on a patient's right and left ears, hot and cold readings, I bill 92543 x 4. Some insurers deny the extra three units and include them in the first. Should I report only one unit of 92543?

Louisiana Subscriber
 
Answer: You are correctly reporting the caloric vestibular tests (92543, Caloric vestibular test, each irrigation [binaural, bithermal stimulation constitutes four tests], with recording). CPT notes that both-ear (binaural), dual-temperature (bithermal) ear irrigations equal four tests. Therefore, you should assign one unit for both-ear and temperature (hot and cold) irrigations.
 
Some carriers don't accept units, however, so you should bill one irrigation per line and append modifier    -59 (Distinct procedural service) to each multiple irrigation. For the denials, you should resubmit the claims and report:

 

92543
 

92543-59
 

92543-59
 

92543-59.
  
If insurers still deny individual irrigation reporting, remind them that although audiologists normally perform four irrigations, CPT's parenthetical descriptor clarifies that each irrigation counts as one test. In addition, send the insurer a copy of Medicare's instructions available at www.gamedicare.com/NewsPubs/mar00/mar00p12.htm that show you should bill 92543 based on the number of irrigations the audiologist performs.