Otolaryngology Coding Alert

Question: Our audiologist performed a VNG test in our office. We reported codes 92540, 92543, 92547, 92557, and 92567. During the examination, the patient was found to also have sensorineural hearing loss, so we submitted diagnoses 389.10 and 386.11. I also charged 99213 with modifier 25 for the office visit. Insurance is denying payment for the 99213-25. I thought if there were additional diagnosis, they should pay for the office visit. Can you please clarify for me?

Wisconsin Subscriber

Answer: It appears that the original intent of the visit was to perform the VNG testing, and that the new problem (sensorineural hearing loss) was detected during the visit/evaluation. If so, the insurance company should pay for it. The E/M service associated with the new diagnosis is considered a separately identifiable, separately reportable service.

Ensure that your provider included sufficient documentation to show that the E/M care related to the new problem (389.10, Sensorineural hearing loss unspecified) was significant enough to merit separate coding.

File the VNG codes in conjunction with diagnosis 386.11 (Benign paroxysmal positional vertigo):

• 92540 – Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording 

• 92543 – Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes 4 tests), with recording 

• 92547 – Use of vertical electrodes (list separately in addition to code for primary procedure) 

• 92557 – Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined) 

• 92567 – Tympanometry (impedance testing).

Report 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components …) with diagnosis 389.10.

Since the claim has already been processed and the E/M denied, you probably need to appeal to get it processed. Send in your notes and make sure they show a significant and separately identifiable E/M service. Point out that the E/M was not for the vertigo, but for the patient’s unrelated hearing complaint. The payer has probably adopted the CCI guidance that says the definition of minor procedures including a small E/M component can be extended to xxx global day services (which was added to the narrative of the CCI back in version 7.2 or 7.3). Not all payers have adopted this policy, but those who have make it harder to get paid for medical services performed with E/M services.