Otolaryngology Coding Alert

Question: I always report 92543 x 4 when our audiologist uses electroneurography (ENG) to record caloric vestibular testing on a patient's right and left ears (hot and cold readings). Sometimes, insurers deny the extra three units and include them in the first. Should I report only one unit of 92543?


Mississippi Subscriber

Answer: You are reporting caloric vestibular tests correctly (92543, Caloric vestibular test, each irrigation [binaural, bithermal stimulation constitutes four tests], with recording).

CPT notes that both-ear (binaural), dual-temperature (bithermal) ear irrigations equal four tests. In this test, the audiologist irrigates the ear with warm and then cold water. If she performs the irrigation on each side (binaural) with dual temperatures (bithermal), she does four irrigations: right ear--warm, cold; left ear--warm, cold. Therefore, you should assign one unit for both-ear and temperature (hot and cold) irrigations.

Some carriers don't accept units, however, so you should bill one irrigation per line and append modifier 59 (Distinct procedural service) to each multiple irrigation.

For the denials, you should resubmit the claims and bill as follows:

- 92543

- 92543-59

- 92543-59

- 92543-59.

If insurers still deny individual irrigation claims, remind them that although audiologists normally perform four irrigations, CPT's parenthetical descriptor clarifies that each irrigation counts as one test. Be sure to pursue your claims through the appeals process if payers still will not reimburse appropriately.