Otolaryngology Coding Alert
Column 'Z' Reveals Supervision Requirements
Question: An audiologist performs audiological tests off-site from the otolaryngologist. Does Medicare permit me to bill these services?
Vermont Subscriber
Answer: Yes. Medicare exempts certain diagnostic tests from general, direct and personal supervision. A code's supervision requirements are in column
"Z" of the National Physician Fee Schedule Relative Value File. If the "Physician Supervision of Diagnostic Procedures" column contains a "5", the
audiologist may perform the test off-site and still bill the service. "Physician supervision policy does not apply when the procedure is personally furnished by a qualified audiologist; otherwise must be performed under the general supervision of the physician," states Medicare Transmittal B-01-28.
An off-site audiologist may perform the following audiologic function tests and bill them under her personal identification number (PIN):
* 92552-92556 - audiometry tests
* 92557 - Comprehensive audiometry threshold ...
* 92561 - Bekesy audiometry; diagnostic
* 92562-92584 - various balance, hearing and audiometry tests
* 92585 - Auditory evoked potentials ... comprehensive
* 92587-92588 - Evoked otoacoustic emissions ...
* 92597 - device evaluation and/or fitting.
Example: A Medicare beneficiary presents with a complaint of hearing loss. After an otolaryngologist takes a history and exam, she orders audiometric
testing. An off-site, otolaryngologist-employed audiologist completes the testing and diagnoses sensorineural hearing loss.
Because Medicare assigns level-five supervision to 92557 (Comprehensive audiometry threshold evaluation and speech recognition [92553 and 92556
combined]), you should report the audiologist's service using her PIN.
The physician does not have to be present in the exam room (personal) or office suite (direct) or provide overall direction and control (general) for the audiologist to perform the comprehensive audiometry evaluation. Link 92557 to the audiologist's findings, sensorineural hearing loss (389.1x).
File an 855R to assign the benefits to the otolaryngologist.
Don't forget: Vestibular function tests with recording (92541-92548) also fall under level five of "Physician Supervision of Diagnostic Procedures."
For a full list of tests, download the Medicare transmittal from www.cms.hhs.gov/manuals/pm_trans/B0128.pdf.
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