Otolaryngology Coding Alert

Question: We were asked to perform a consultation for a hospital inpatient who was transported to our office (our office is connected to the hospital). We administered hearing tests (tympanometry and a comprehensive threshold evaluation and speech recognition). There seem to be new Medicare guidelines, so I’m no longer sure how to code the service. What is the proper place of service? 

Wisconsin Subscriber 

Answer: From the time a patient is admitted to the hospital until discharge, he is considered an inpatient. All consultations provided during this time are coded as inpatient, even if the consult is physically provided outside the hospital. Therefore, the place of service for the consultation should be 21 (Inpatient hospital). 

Submit 99222 (Initial hospital care, per day, for the evaluation and management of a patient …) for the consult. A Medicare patient that is inpatient has all the technical components of their diagnostic tests covered under Part A. Therefore, if the audiometry you performed does not have a breakdown of technical and professional components, you will be unable to bill these services. However, if you performed services that have this breakdown in the Medicare fee schedule, you can bill what was performed with the -26 modifier (Professional component) only. You are not entitled to the total component and full fee schedule as long as the patient is registered as an inpatient. 

The same would apply if a Skilled Nursing Facility (SNF) patient was brought to your office, as they are considered inpatients. If the patient is not a Medicare Part B patient, you can try to bill the audiometry codes and see what the payer’s policies are. However, as mentioned above, your place of service must be 21 for inpatient.