Otolaryngology Coding Alert

Question: A Medicare beneficiary presents complaining only of hearing loss. After the otolaryngologist takes a history and exam, an employed audiologist performs audiometric testing. She diagnoses sensorineural hearing loss and recommends, but does not dispense, hearing aids. Is the audiogram 92557 a payable service? What if she had dispensed hearing aids?

Florida Subscriber

Answer: Medicare permits audiometric testing, such as pure tone audiometry (92552-92553), speech audiometry (92555-92556) and comprehensive audiometry (92557), under certain conditions. To qualify for coverage, the otolaryngologist must order the test to select the type of medical or surgical treatment needed for a hearing deficit or other medical problem. Medicare will not cover a test that the physician performs only to determine the type of hearing aid needed. In addition, the provider contains no hearing-aid benefit and will not pay for the device. But dispensing equipment does not invalidate the testing if it meets the above requirements, which your scenario does.

Because your otolaryngologist had the audiologist conduct the test to evaluate the patient's need for treatment, Medicare will cover 92557 (Comprehensive audiometry threshold evaluation and speech recognition [92553 and 92556 combined]). You should report the physician's service with the appropriate office visit code (99201-99215, Office visit for a new or established patient). Make sure to append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 992xx to indicate that a significant, separately identifiable E/M service led to the audiometric testing. Link the patient's complaint of hearing loss (388.40, Abnormal auditory perception, unspecified) to the office visit. Use the audiologist's findings, sensorineural hearing loss (389.1x), as the diagnosis for the test.

The patient now has an existing sensorineural hearing loss diagnosis. Therefore, Medicare will not cover subsequent testing. So, if the patient returns for hearing aids, Medicare will not cover retesting.