Otolaryngology Coding Alert

If your audiology technician's notes indicate that she performed the test and the ENT provided direct supervision, her services will pass a Medicare auditor's main focus.

You had better check with your carrier for specific technician requirements. Medicare is leaving specific technician requirements open to regional interpretations, but the national policy calls for the technician to meet at a minimum these criteria:

1. any applicable state or local laws

2. successful completion of a curriculum that includes classroom training and supervised clinical experience administering audiological service.

You-ll also have to check with your carrier for what tests it will allow technicians to perform. CMS "will leave it to the carriers to determine what they will cover as technician-performed," says Robert C. Fifer, PhD, associate professor and director of audiology and speech pathology at the University of Miami's Mailman Center for Child Development in Florida and a member of the American Speech-Language-Hearing Association's Health Care Economic Committee. The transmittal is vague on these specifics.

A technician may perform the technical part of audiological evaluations while an otolaryngologist furnishes the interpretation. With the exception of screening tests (92551) and tympanograms (92567), audiologic function tests with medical diagnostic evaluation (92552-92557, 92561-92584, 92585, 92587-92588, 92596) require an audiologist's skills. For vestibular function tests (92541-92548), a physician or qualified nonphysician practitioner (NPP) with an audiologist's skills may directly supervise and provide an audiologist's skills while a technician furnishes the services.

When a qualified technician performs an audiological evaluation, you-ll have to educate your otolaryngologists and qualified NPPs to document the service's professional component. This includes "clinical decision- making and other active participation in the delivery of the service," CMS Transmittal 84 says.

Key: Auditors will be focusing on these items:

- the technician's name and professional identity

- the specific tests the physician ordered

- direct supervision by the NPP or MD.

Claims involving a technician-administered service will be blind to this detail. CMS instructs the physician or NPP to bill the test directly using the global code.

Example: An otolaryngologist orders a qualified technician to perform a binaural, bithermal caloric vestibular test (92543 x 4, Caloric vestibular test, each irrigation [binaural, bithermal stimulation constitutes four tests], with recording), which the physician directly supervises and interprets. All sign the medical record. You should report the global code 92543 x 4 for both the technician's technical performance and the physician's interpretation under the otolaryngologist's NPI.