Otolaryngology Coding Alert

Question: Our otolaryngologists sometimes order hearing tests by phone to the audiologists they use. Does the ENT then have to sign a written order that we fax to the audiology office?

New Jersey Subscriber

Answer: CMS just clarified that the physician does not have to sign the order. Transmittal 94 Change Request 6100 updates the Internet Only Manual chapter 15, section 80.6.1, "Requirements for Ordering and Following Orders for Diagnostic Tests; Definitions," effective Aug. 29, 2008.

When an otolaryngologist communicates an "order" that an audiologist perform a diagnostic test, such as 92557 (Comprehensive audiometry threshold evaluation and speech recognition [ 92553 and 92556 combined]) for a beneficiary via a telephone call to the testing facility, documentation must include these items:

- the physician/practitioner or his/her office, and the testing facility must document the telephone call in their respective copies of the beneficiary's medical records.

- "the physician must clearly document, in the medical record, his or her intent that the test be performed," according to the added language.

Don't miss: In fact, your physicians do not have to sign any orders for diagnostic tests. "- a physician's signature is not required on orders for clinical diagnostic tests (including x-ray, laboratory, and other diagnostic tests) that are paid on the basis of the clinical laboratory fee schedule, the Medicare physician fee schedule, or for physician pathology services," according to MLN Matters Number: MM6100.

Crucial: The physician, however, must clearly document in the medical record his or her intent that the test be performed, indicates the MLN. That means CMS still requires an order.

CMS inadvertently omitted the non-signature, intent requirements previously contained in the Medicare Carriers Manual section 15021 when the Medicare Benefit Policy Manual was published. View the transmittal at http://www.cms.hhs.gov/transmittals/downloads/R94BP.pdf and the provider education article at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6100.pdf.