Otolaryngology Coding Alert

Question: We were asked to evaluate a hospital inpatient who was wheeled via gurney to our office (our office is connected to the hospital). We examined the patient during a level-two visit, and administered hearing tests (tympanometry and a comprehensive threshold evaluation and speech recognition). What is the proper place of service?

Wisconsin Subscriber

Answer: From the time a patient is admitted to the hospital until discharge, they are considered an inpatient. All evaluations provided during this time are coded as inpatient, even if the consult is physically provided outside the hospital. Therefore, the place of service for the evaluation should be 21 (Inpatient hospital).

Submit 99222 (Initial hospital care, per day, for the evaluation and management of a patient …) for the consult. A Medicare patient that is inpatient has all the technical components of their diagnostic tests covered under Part A. Therefore, if the audiometry you performed does not have a breakdown of technical and professional components, you will be unable to bill these services. However, if you performed services that have this breakdown in the Medicare fee schedule, you can bill what was performed with the 26 modifier (Professional component) only. You are not entitled to the total component and full fee schedule as long as the patient is registered as an inpatient.