Otolaryngology Coding Alert

Question: The audiologist in our practice sees a patient and provides hearing tests, which we report as 92557 (Comprehensive audiometry threshold evaluation and speech recognition [92553 and 92556 combined]) and 92567 (Tympanometry [impedance testing]). If one otolaryn-gologist in the practice interprets the test and provides a diagnosis, can the interpretation be reported separately?

Massachusetts Subscriber

Answer: The interpretation cannot be reported separately. Neither 92557 nor 92567 is broken down into technical (modifier -TC) and professional (modifier -26) components, and the only way to report these services is with the global (total) code.

Even if these codes comprised two components, the practice can bill only for one interpretation. And if the audiologist has already reported the global code (by billing the appropriate audiology test code without a modifier), all the reimbursement available for the service will be paid for the audiologists service, and there is no more for the physician to claim.

If the audiologist is not an employee of the practice, it may be appropriate to consider the interpretation by the otolaryngologist separately. This does not mean that the service may be reported to Medicare carriers because the Medicare fee schedule does not break out the components separately. The review of the test, however, can contribute positively to the medical decision-making (MDM) and overall level of the E/M encounter.

Note: The national Physicians Fee Schedule Relative Value Guide includes separate listings for all three variations when applicable. To report the total or global amount of both components, you should not append a modifier.

The diagnosis determined by the test should be used for the test itself. When the interpretation contributes to the MDM of an E/M visit, the appropriate diagnosis that prompted the visit (such as the test results) should be linked to the appropriate E/M code.