Otolaryngology Coding Alert

Question: Our practice employs an audiologist who 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.

You can find a code's supervision requirements 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 you can still bill the service.

-Physician supervision policy does not apply when the procedure is personally furnished by a qualified audiologist; otherwise the procedure must be performed under the general supervision of the physician,- states Medicare Transmittal B-01-28.

Examples of the audiologic function tests that an off-site audiologist may perform and bill under her personal identification number (that is, you are not billing incident-to the physician) include:

- 92552-92556--Audiometry tests

- 92557--Comprehensive audiometry threshold ...

- 92561--Bekesy audiometry; diagnostic

- 92562-92584--Various balance, hearing and audiometry tests

- 92585-TC--Auditory evoked potentials ...; comprehensive; technical component

- 92587-TC-92588-TC--Evoked otoacoustic emissions; ... technical component.

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 form 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/Transmittals/Downloads/B0128.pdf.

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.; and Charles F. Koopmann Jr., MD, MHSA, professor and associate chair at the University of Michigan's department of otolaryngology in Ann Arbor.