Otolaryngology Coding Alert

Question: Our practice does all of the newborn hearing screenings at a local hospital for babies born there. We’ve traditionally reported the service with 92586, but have recently received several denials stating that payment was made to the hospital as part of the birth charges. The denial also states that it’s inappropriate for a provider to bill only a technical component for 92586 in an inpatient/outpatient place of service. All of our claims go out as inpatient since the babies are technically inpatients at birth. Any suggestions?

Illinois Subscriber

Answer: What the payer states is true. A newborn hearing screening that is billed to a provider other than a contracted inpatient facility will be denied as incidental. The service is included in the facility’s case rate and will not be paid separately. 

Code 92586 (Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; limited) currently has an associated national facility fee of $84.18. You’ll need to work out an arrangement with the hospital to determine which portion of that fee should be shared with your physicians so they can be paid.