Otolaryngology Coding Alert

Question: Our otologist interprets electronystagmogram (ENG)/videonystagmography (VNG) results before meeting with the patient. He then goes over this result with the patient, carefully documents his efforts, and  dictates his evaluation in his note. Which modifier can we report to appropriately represent these services?

Ohio Subscriber

Answer: Codes 92540-92546, covering ENG/VNG tests, are broken into professional (modifier 26) and technical components (TC). The otologist, however, cannot double dip for these services. If he is reporting the ENG/VNG either by (a) his employed audiologist billing the ENG/VNG global or (b) a technologist providing the test and the physician billing the global, the otologist is getting paid for the interpretation. The audiologist or technologist provides the technical component and the

otologist provides the interpretation. They both get paid through the global code, such as 92543 (Caloric vestibular test, each irrigation [binaural, bithermal stimulation constitutes 4 tests], with recording). If an outside audiologist (not an employee of the otologist's practice), performs the test, the audiologist should be billing the technical component only (TC on the test code) and the otologist would bill the interpretation with modifier 26 on the ENG/VNG. For instance, if an ENT ordered calorics and sent the patient to an outside audiologist, the audiologist would report the test with 92543-TC and the ENT would report his interpretation with 92543-26.

Twist: If the otologist is having an in-office audiologist perform the test and then the physician is interpreting it, the physician interpretation is included in the ENG/VNG code. The otologist cannot then bill separately for this interpretation.

Bottom line: Consider the diagnostic possibilities and test ordering as part of the E/M's medical decision making , which could affect the E/M service's level, such as 99201-99215 (Office or other outpatient visit for the evaluation and management of a new patient ...).