Otolaryngology Coding Alert

Question: We are having trouble with our VNG claims for the last quarter of 2014. We were billing with 92547, 92270-59-76, 92546-59, 92546-59-76, and 92542-59 per the instructions from the representative who sold us the equipment. We started receiving denials from Medicare starting Oct. 1, 2014. What is the correct billing for these procedures for all of 2014, including any changes from October and how should we be billing for 2015? 

Nevada Subscriber

Answer: The MUE (medically unlikely edit) value for 92546 (Sinusoidal vertical axis rotational testing) is 1, which means you cannot bill two units of the code to Medicare. That could be part of the reason your second item of 92546 is being denied. 

In addition, CCI edits consider 92547 (Use of vertical electrodes [List separately in addition to code for primary procedure]) to be included in the service of 92270 (Electro-oculography with interpretation and report). Therefore, you would need to append a modifier to 92547 to “break” the edit and report both procedures during the same encounter. 

A third detail to check is whether the name of the ordering physician is on the claim. This is a mandate from Medicare and the entire claim might be denied if the name is documented correctly.