Otolaryngology Coding Alert

Claim otolaryngologist's service with -26,  -TC and/or E/M

If you know when to use modifier -26 or -TC with ENG codes and what the components include, you won't be leaving deserved money on the table.

Break Out Off-Site Test/Report

Be sure that you code for the proper electronystagmography (ENG) test components. The ENG codes (92541-92546) have a professional component (modifier -26) and a technical component (modifier -TC). "You can bill the ENG globally or split with modifier -26 or -TC depending on who does what," says Debbie Abel, AuD, audiologist at Northern Arizona Speech and Hearing Center in Sedona, Ariz., and owner of Alliance Audiology in Alliance, Ohio. 
 
Here's how:
 1. If your otolaryngologist owns the equipment, reads the test, and writes a report, you use the global code (92541-92546) and receive payment for both the professional and technical components.
 2. If the otolaryngologist owns the equipment but sends out the test for reading, you append modifier -TC to the ENG code to indicate you are billing for only the technical (equipment) component.
 3. If a non-employee, such as a hospital audiologist, performs the ENG and the otolaryngologist reads the test and issues the report, you should use the same CPT codes with modifier -26.
 
Modifier -26 tells the insurer that you are billing for only the professional (reading and reporting) component.

Payment: The professional and technical components add up to the same payment as the global fee ENG code with no modifier.

Use E/M Code for Evaluation

You may wonder whether coding for the professional work overrides a same-day E/M (such as 99212-99215, Office visit for the evaluation and management of an established patient ...). "We employ audiologists that perform the ENGs, and then the patient sees the otolaryngologist for further evaluation once the test is complete," writes Camille White, administrator at The ENT Center of Central Georgia and Central Georgia Head & Neck Surgery Center in Macon. "Can we bill an office visit in addition to the testing?"
 
Good news: The professional work doesn't overlap with an E/M service. "You could report an E/M code for the time the otolaryngologist spends evaluating the patient and going over the test results with the patient," Abel says. The professional component pays the otolaryngologist for reading the test and documenting why he agrees or disagrees with the test's findings.
 
In fact, coding a separate office visit in this situation would be typical, says Michael J. Thielman, MD, an otolaryngologist with Rice Medical Center in Wisconsin Rapids, Wis. "You often see the patient the first time as a new patient or consult encounter, and then have the ENG  and follow-up visit."
 
Tip: You don't need modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) or a different diagnosis to report an E/M code on the same day as an audiological diagnostic test.