Wiki How to properly bill 92601-92604

[lemorford]

I was wondering how people are billing 92601-92604 for unilateral and bilateral situations and if they are getting denials or payments. I have read to use modifier 50, RT & LT, or 22 to indicate bilateral, but our coding program says that these CPT codes do not allow any of those modifiers and that 92601-92604 is representative of a bilateral procedure and to add modifier 52 if performed unilaterally. Any insight on this issue would be greatly appreciated! Thank you!!!

 

[kpichon]

http://www.asha.org/Practice/reimbursement/medicare/audiology-medicare-documentation-FAQs/


How do I indicate that I performed only unilateral testing?

As indicated in the Current Procedural Terminology (CPT) manual, the Audiologic Function Tests (Codes 92550 through 92700) include the testing of both ears. If only one ear instead of two ears is tested, the -52 modifier (Reduced Services) should be utilized.
The one exception to this relates to the use of 92601-92604, which involves the post-operative analysis, fitting, and adjustments of a cochlear implant. Given that this code is described in the singular application, this code in isolation would be insufficient to address the analysis, fitting and adjustments of a bilateral cochlear implantation. In these circumstances, where bilateral cochlear implants are fit and managed, we recommend that a -22 modifier (Unusual procedural service) be added to the applicable code of 92601-92604 and that the necessary documentation be submitted with the claim. This documentation should outline what differentiates a singular cochlear implant fitting/remapping from a bilateral cochlear implant fitting/remapping and it should address any additional time, equipment, staffing, etc. required. Some payors may require the RT modifier to indicate the right ear and the LT modifier to indicate the left ear when there are bilateral cochlear implants.

Another reference:
http://www.audiologist.org/_resources/documents/professionals/reimbursement/Codes_CPT.pdf