Otolaryngology Coding Alert

Question: Our multispecialty practice is considering hiring an audiologist. She may perform hearing testing on days when a physician from another specialty, such as ophthalmology, is in the office and the otolaryngologist is in the OR. Does the physician have to be an ENT doc, or in our case, can the ophthalmologist be the MD?

Pennsylvania Subscriber

Answer: A qualified audiologist can perform audiological diagnostic testing and hearing aid servicing without a supervising physician, so the physician's specialty does not come into play. Medicare defines a qualified audiologist as one who has her master's or doctoral degree in audiology and either has a state license (in a state that licenses audiologists) or has completed the practicum, performance, and exam requirements necessary (in a state that does not license audiologists) (Pennsylvania does license audiologists).

If you're talking about the physician's role as the referring physician, the physician could be from another specialty other than otolaryngology. Any physician qualifies as a referring physician for ordering the testing.

"Contractors should not base payment decisions for audiological diagnostic tests solely on the specialty of the person ordering the test," according to CMS transmittal 84 (www.cms.hhs.gov/Transmittals/downloads/R84BP.pdf; see table number 5717.6).

The test, however, must be of medical value. CMS states that "tests must be for the 'purpose of obtaining information necessary for the physician's diagnostic medical evaluation or to determine the appropriate medical or surgical treatment of a hearing deficit or related medical problem.' If a physician orders a test but has no appropriate diagnostic or medical use for the results, then the reason for the test may be questioned."

Error averted: Before billing Medicare, the audiologist must get her own national provider identifier (NPI) and personal identification number (PIN). Medicare requires that audiologists report audiological diagnostic tests directly under their own NPI, rather than incident to a physician. So you would report the audiological diagnostic test code under the audiologist's NPI. This way the supervising physician's qualifications are not an issue.