Otolaryngology Coding Alert

Question: A patient presented to the audiologist for diagnostic testing without a physician’s order. The workup was thought to be for non-acute hearing conditions, but the audiologist unexpectedly discovered an acute condition. How should we handle this?

Kansas Subscriber

Answer: In the event of the unexpected discovery of an acute condition during a visit with an audiologist without the order of the treating physician or non-physician practitioner (NPP), you may bill modifier AB (Audiology service furnished personally by an audiologist without a physician/npp order …) with each of the services the audiologist provided.

“The presence of the acute condition won’t be cause to deny the claim, provided that good faith efforts were made, as documented in the medical record, to avoid providing audiology services for acute conditions without the order of the treating physician or NPP,” according to the Centers for Medicare & Medicaid Services (CMS).

In other words, when an audiologist performs testing without an order from a treating physician or NPP and unexpectedly discovers an acute condition, they should be sure to document that good faith efforts were made to provide services for non-acute hearing conditions so that the claim will not be denied.