Otolaryngology Coding Alert

Warning:  Avoid 92520 with 92612-92616

Although CPT added a host of new codes for fiberoptic endoscopic evaluation of swallowing (FEES) and fiberoptic endoscopic evaluation of swallowing with sensory testing (FEEST) in 2003, questions still linger concerning the correct method to report these services.

Here are two important points to remember:
 
- Your physician can't bill merely for supervising the procedures, and;

- If a nonphysician performs these procedures, he must report them incident-to the physician's services.

Become Familiar With the Codes

You can find codes for FEES and FEEST in the -Medicine: Special Otorhinolaryngologic Services- portion of CPT. Five primary codes describe complete evaluations of this type:

- 92610--Evaluation of oral and pharyngeal swallowing function

- 92611--Motion fluoroscopic evaluation of swallowing function by cine or video recording.

- 92612--Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording

- 92614--Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording

- 92616--Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording.

In addition, CPT includes three codes for physician interpretation and report only:

- 92613--Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording; physician interpretation and report only

- 92615--Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording; physician interpretation and report only

- 92617--Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording; physician interpretation and report only.

You should assign 92612, 92614 and 92616 only if the physician both performs the evaluation and provides the interpretation and report, says Teresa Thompson, CPC, CCC, with TM Consulting in Sequim, Wash.

Caution: You cannot report 92612, 92614 and 92616 if the physician merely supervises a technician who conducts the evaluation.

Two to watch: Generally, you will not report 92610 or 92611 for physician services (although you may). Medicare recognizes these codes, but the physician fee schedule does not assign any physician work relative value units (RVUs) to these procedures. In this case, Medicare does not allow any physician work RVUs because the agency assumes a technician will perform 92610 and 92611.

Evaluations Must Be Separate

You may report physician interpretation and report (92613, 92615 and 92617) when a technician provides the evaluation and the physician provides a -separately identified physician review and interpretation of the fiberoptic endoscopic evaluation,- according to a typical Medicare LCD. CMS grants 0.71 RVUs for 92613, 0.63 RVUs for 92615, and 0.79 RVUs for 92617 (in the range of $23-$29 each).

Bottom line: A physician must review the test and provide a separate interpretation. Merely reviewing the administrating technician's findings will not support a claim of 92613, 92615 or 92617, Thompson says.

Bundles Matter

 Keep in mind when reporting 92612-92616 that these more specific codes overlap with the general laryngeal study code 92520 (Laryngeal function studies). Because the FEES/FEEST codes include a general study, the National Correct Coding Initiative (NCCI) bundles 92520 into 92612-92616.

In a nutshell: You should not report 92520 in addition to 92612-92616.

In addition, the NCCI bundles -lesser- evaluations to -more extensive- evaluations of a similar type. Therefore, 92610 is a component of 92611; both 92610 and 92611 are a component of 92612; 92610, 92611 and 92612 are all components of 92614, and so on.

Watch for Incident-To

You may report 92610, 92611, 92612, 92614 and 92616 for services provided by a physician or speech pathologists, according to local coverage determinations published by Empire Medicare (Part B provider for New York and New Jersey) and other Medicare payers. If a speech pathologist provides these services, however, you must report the codes incident-to the physician's services.

Supervision and plan of care is a must: To report 92610, 92611, 92612, 92614 and 92616 incident-to, specially trained and credentialed speech pathologists who perform these services must do so under the direct supervision of a physician (who designs the plan of care) to receive Medicare reimbursement.

Direct supervision in the office setting does not mean that the physician must be physically present in the same room with the auxiliary personnel. But the physician must be present in the office suite and immediately available to provide assistance and direction throughout the time the auxiliary personnel is performing services, says Quinten A. Buechner, MS, MDiv, CPC, president of ProActive Consultants LLC in Cumberland, Wis. Availability of the physician by phone does not constitute direct supervision.