Otolaryngology Coding Alert

Question: Our audiologists sometimes bill 92604 with 92626 and 92627 for our follow-up cochlear implant patients. Are we allowed to bill if they are testing both sides?

Delaware Subscriber

Answer: According to the latest Correct Coding Initiative (CCI) edits, 92626 (Evaluation of auditory rehabilitation status; first hour) is a Column 2 code of 92604 (Diagnostic analysis of cochlear implant, age 7 years or older; subsequent reprogramming). That means you should not normally report both codes for the same patient encounter. However, in some circumstances you can append a modifier to 92626 and include documentation to differentiate between the services. You can submit 92627 (Evaluation of auditory rehabilitation status; each additional 15 minutes [list separately in addition to code for primary procedure]) as an add-on code with 92626, as needed.

CPT^® coding guidelines state that CMS recommends you append modifier 22 (Increased procedural services) when billing bilateral analysis, fitting, and adjustments of bilateral cochlear implants (CI). In your case, the applicable code would be 92604.

Reimbursement for binaural CI programming varies between payers. Consult your payer(s) to determine if CI programming codes (92601-92604) are considered unilateral or single device codes.

Some payers may accept two line items of the same code with RT (Right side) or LT (Left side) ear modifiers to designate which side was programmed.

Other payers may consider a binaural programming session as a same-day repeat procedure. In this case, a separate bill with the same date of service would be completed. The second CI programming code would be billed with a repeat procedure modifier added (76, Repeat procedure or service by same physician or other qualified health care professional; or 77, Repeat procedure by another physician or other qualified health care professional).