Otolaryngology Coding Alert

Question: Can we bill independently under the audiologist for VNG testing done in the office by the audiologist?

Kansas Subscriber

Answer: First, pay attention to the appropriate code, 92540 (Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording). The PC/TC indicator for 92540 is “1,” which means the service has both professional and technical components.

If your physician performed professional component, then you should bill 92540 with modifier 26 (Professional component); the qualified audiologist or audiologist technician should bill with modifier TC (Technical component). But if the qualified audiologist performs the entire testing, both the professional and technical components, the practice can bill the entire service under only the audiologist with no modifier. The doctor does not need to be involved beyond providing the order for the testing. Remember that all diagnostic testing like audiometric testing requires a physician’s order before performing the test.

Take note: Remember that modifiers 26 and TC should be billed under different TINs. Otherwise, they will be considered as services performed by the same physician or group and the claim could be denied. If the technician does not have separate TIN, you can bill the service without any modifiers under the TIN of your physician and make internal arrangements for the payment of technician.

If the audio tech works for the audiology TIN and does the technical component, and the qualified audiologist performs the professional component, the testing can be billed out under the NPI for the audiology practice with no modifier. Keep in mind that audio techs can only perform audiometric testing for Medicare patients which have both a technical and professional component such as vestibular testing.