Audiology Coding and Billing Questions Answered Audiology associations have created a single online resource on diagnosis and procedure codes, Medicare, medical necessity and other issues. Bottom Line
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Bottom Line  |   July 01, 2017
Audiology Coding and Billing Questions Answered
Author Notes
  • Neela Swanson is ASHA director of health care coding policy. nswanson@asha.org
    Neela Swanson is ASHA director of health care coding policy. nswanson@asha.org×
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Hearing Disorders / Practice Management / Telepractice & Computer-Based Approaches / Bottom Line
Bottom Line   |   July 01, 2017
Audiology Coding and Billing Questions Answered
The ASHA Leader, July 2017, Vol. 22, 32-33. doi:10.1044/leader.BML.22072017.32
The ASHA Leader, July 2017, Vol. 22, 32-33. doi:10.1044/leader.BML.22072017.32
What’s the appropriate billing code for a hearing test if the patient has no hearing loss? What if an audiologist feels a procedure is medically necessary—but the patient’s insurer disagrees?
To help audiologists find the correct information to these and other billing- and coding-related questions, reimbursement experts from several audiology groups—ASHA, the Academy of Doctors of Audiology, the American Academy of Audiology and others—have created resources that provide consistent, accurate and unified responses to common coding issues.
After several years of collaboration, the result is “Ask Your Audiology Organizations,” a single, easy-to-navigate online resource that covers a wide array of coding and payment policy issues for audiologists, including Medicare regulations, diagnosis and procedure coding guidance, medical necessity considerations, and third-party payer contracts. The site reduces the chance that audiologists will find conflicting guidance from different resources.
Here are excerpts from some of the questions and answers (billing codes refer to Current Procedural Terminology [CPT] codes, © American Medical Association).

The new site reduces the chance that audiologists will find conflicting guidance from different resources.

What ICD-10 code (International Classification of Diseases, 10th Revision) do you report when results of diagnostic tests are normal?
Coding for diagnostic tests should be consistent with the following guidelines:
  • Code for the result of the diagnostic test.

  • In the case of a normal result, the next step would be a diagnosis code that reflects the reason for the referral and/or the chief presenting complaint.

  • It is helpful to include other, secondary diagnosis codes that paint a clear clinical picture of why the tests are being performed.

To bill CPT codes 92568 (acoustic reflex testing), 92550 (tympanometry and reflex threshold measurements) and 92570 (acoustic immittance testing, includes tympanometry) do you have to obtain both ipsilateral and contralateral acoustic reflex thresholds?
Yes. To appropriately bill for acoustic reflex testing, you must perform both contralateral and ipsilateral reflexes. If you are performing only ipsilateral reflexes, you must append the –52 modifier to indicate reduced services. The reduced-services modifier is not required for incomplete stimulus frequencies if there is a combination of the four test conditions necessary to obtain the complete diagnostic information.
However, if one or more of the test conditions is not performed (for example, two contralateral stimulations and one ipsilateral stimulation or two contralateral stimulations only), then using the reduced modifier –52 is appropriate. It signifies that the basic protocol for the procedure has not been altered, but the entire procedure has not been performed, according to guidance in the American Medical Association’s June 2009 “CPT Assistant.”
An ipsilateral acoustic reflex screening at 1000 Hz does not meet the coding criteria for 92568, because the protocol for this procedure requires that you obtain the threshold level for the acoustic reflex and not simply observe the presence or absence of an acoustic reflex at a single intensity level.
What if there is a service that I feel is in the patient’s best interest that the insurance company does not consider to be medically necessary?
Insurers do not always pay for everything that a provider believes to be necessary. For example, Medicare does not cover routine annual hearing testing to monitor hearing (and hearing aid) status for beneficiaries. Providers may, however, bill a patient directly for this service. Make sure that you follow the specific guidelines of the patient’s insurer for notifying the patient of non-coverage (including use of appropriate CPT modifiers).

“Incident to” billing frequently takes place in audiology and medical offices, but not always in compliance with CMS rules.

What is “incident to” billing?
According to the Centers for Medicare and Medicaid Services (CMS) requirements for Medicare Part B billing, “incident to” services are procedures that “are furnished as an integral, although incidental, part of the physician’s personal professional services …. ”
“Incident to” services are billed using the physician’s NPI (National Provider Identifer), but are performed by ancillary or nonphysician personnel (such as technicians, nurses or audiology assistants).
“Incident to” refers only to which provider performs the service. It is not related to the clinic, facility or the entity receiving payment, but rather to the professional who provided the service, and is listed in box 24J of the CMS 1500 form.
“Incident to” billing frequently takes place in audiology and medical offices, but not always in compliance with CMS rules. Here are two examples of prohibited “incident to” billing:
  • An audiologist employed by a physician completes a diagnostic hearing test (92557), which is then billed to Medicare as “incident to” using the physician’s NPI. However, when the service is completed by an audiologist, the audiologist’s NPI—not the physician’s—should be used for billing.

  • An audiology assistant employed by an audiologist completes a hearing test, which is then billed to Medicare as “incident to” using the audiologist’s NPI. However, services completed by audiology assistants should not be billed as “incident to” an audiologist.

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July 2017
Volume 22, Issue 7