Otolaryngology Coding Alert

Question: You explain in June 2005's Otolaryngology Coding Alert article "Discover the Reasoning Behind ENG Tests Unit Rules" that we may now report 92547 eight times on a single claim. How can we ensure we receive correct payment for this code?


New York Subscriber
Answer: Watch how often you bill the electrode placement code based on the claim's service date. Prior to Jan. 1, 2005, you should have reported +92547 (Use of vertical electrodes [list separately in addition to code for primary procedure]) once per date of service, according to Empire Medicare Services. Medicare should have paid the add-on code per ENG session at about $45.18 (national rate).

On and after Jan. 1, 2005, you should bill 92547 in addition to each vestibular test the audiologist performs. Refile claims from Jan. 1 to the present with the correct number of units. Expect to report 92547 for a "usual" ENG as follows:
  92541 x 1 unit
  92542 x 1 unit
  92543 x 4 unit 
  92544 x 1 unit
  92545 x 1 unit. You would bill 92547 per test for a total of eight units of 92547. Medicare now reimburses 92547 at the per-test rate of $5.31 (0.14 relative value units [RVUs] as compared to 1.21 RVUs in 2004). So you can expect about $42.48 in total electrode placement payment. The 2005 payment rate cuts about $2.70 from your 92547 reimbursement, provided you capture the correct number of units.

Make sure also to monitor private payers' policies to see if the companies adopt Medicare's change. Let them know the new accepted way with Empire's bulletin available at http://www.empiremedicare.com/mr/nj/VerticalElectrodes.htm. Answers to You Be the Coder and Reader Questions provided by Debbie Abel, AuD, audiologist at Northern Arizona Speech and Hearing Center in Sedona, Ariz., and owner of Alliance Audiology in Alliance, Ohio.; Ellen Allison, RHIA, CPC, a coding instructor and consultant in Buffalo, N.Y.; Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Brick, N.J.; Julie Keene, CPC, an otolaryngology coding and reimbursement specialist at University ENT Specialists in Cincinnati.; and Charles F. Koopmann Jr., MD, MHSA, professor and associate chair at the University of Michigan's department of otolaryngology in Ann Arbor.