Otolaryngology Coding Alert

Question: Our practice has started to receive denials for E/M services provided during the same session as audiologic tests. I dont understand why, since the edits that were introduced and suspended last year do not seem to have been reintroduced. Have I missed something?

New Jersey Subscriber

 
Answer: Like most diagnostic tests, audiology tests have XXX global days (i.e., they are not subject to global surgery guidelines). In November 2000, the Correct Coding Initiative (CCI) bundled most E/M services with most services with XXX global days. The edits were suspended in January 2001. Although these edits have not been reintroduced, the introduction to CCI version 8.0 restates that modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) should be appended to E/M services performed during the same session as services with XXX global days. Although it is not yet known if the edits themselves will be reintroduced, denials of E/M services performed at the same time as XXX procedures are already being reported.
 
Modifier -25 should be appended only if the E/M service involves more than what the CCI describes as the inherent preprocedure, intra-procedure, and postprocedure work usually performed each time the procedure is completed. Even if the guideline is once again suspended and modifier -25 is not required, otolaryngologists should not bill for separate E/M services unless a significant, separately identifiable service is performed.
 
In case of audiology, however, modifier -25 is virtually always appropriately appended to the E/M service performed by the otolaryngologist, because the audiologist (not the physician) performed the test and, therefore, there should be no question that the otolaryngologist performed a significant, separately identifiable service.

  You Be the Coder and Reader Questions were answered by Andrew Borden, CPC, CCS-P, CMA, reimbursement manager for the department of otolaryngology at the Medical College of Wisconsin in Milwaukee; Susan Callaway, CPC, CCS-P, a coding and reimbursement specialist and educator in North Augusta, S.C.; Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J.; Lee Eisenberg, MD, an otolaryngologist in private practice in Englewood, N.J., and a member of CPTs Editorial Panel and Executive Committee; Tara Kaye, appeals coordinator with Atlanta ENT, a large otolaryngology practice with offices throughout metropolitan Atlanta; Melissa Pointer, CPC, billing manager with the otolaryngology division at the University of Arkansas Medical Center in Little Rock.; and Teresa Thompson, CPC, an otolaryngology coding and reimbursement specialist in Sequim, Wash.