Otolaryngology Coding Alert

Question: Encounter notes indicate that the otolaryngologist performed a bithermal caloric vestibular test. She performed a warm and cool irrigation in the right ear, and a warm irrigation in the left ear. Is this a full test, or would we have to code it as reduced services?

Minnesota Subscriber

Answer: Since the otolaryngologist didn’t perform a cool irrigation in the patient’s left ear, the service is reduced. On the claim, report 92537 (Caloric vestibular test with recording, bilateral; bithermal ([i.e., one warm and one cool irrigation in each ear for a total of four irrigations]) for the test with modifier 52 (Reduced services) appended to show that you are not coding for a complete test.

Explanation: In order to report 92537 with no modifier, you must have evidence of both a warm and a cool irrigation in both of the patient’s ears.

Also: For monothermal caloric vestibular tests, you’ll need to be sure that the physician performs an irrigation in each ear before reporting 92538 (… monothermal [i.e., one irrigation in each ear for a total of two irrigations]). If the physician only irrigates a single ear during a monothermal test, report 92538-52.

Indicate that the provider performed 75 percent of the test in box 19 of the claim form; this will help the payer calculate the reduced portion of the claim.