Confusion Surrounds Pediatric Audiology Billing If there’s no code for new technology, how do you bill it? Three audiology organizations develop answers to frequently asked questions. Bottom Line
Bottom Line  |   July 01, 2014
Confusion Surrounds Pediatric Audiology Billing
Author Notes
  • Neela Swanson is ASHA director of health care coding policy.
    Neela Swanson is ASHA director of health care coding policy.×
Article Information
Hearing Disorders / Practice Management / Bottom Line
Bottom Line   |   July 01, 2014
Confusion Surrounds Pediatric Audiology Billing
The ASHA Leader, July 2014, Vol. 19, 26. doi:10.1044/leader.BML.19072014.26
The ASHA Leader, July 2014, Vol. 19, 26. doi:10.1044/leader.BML.19072014.26
Billing for pediatric audiology services can cause confusion for various reasons: Codes don’t reflect current technology or a certain test has no specific billing code associated with it, for example.
A new resource helps with these issues. Audiology reimbursement experts from ASHA, the Academy of Doctors of Audiology and the American Academy of Audiology developed an online set of questions and answers for clinicians who provide pediatric services. Here are excerpts from some of the questions and answers you will find (billing codes refer to Current Produral Terminology codes, © American Medical Association).
Is speech audiometry included in the codes for conditioning play audiometry (92582) and visual reinforcement audiometry (9279)?
Two characteristics differentiate CPT codes 92579 (VRA) and 92582 (CPA): the method of response reinforcement and the types of stimuli. These codes are historical and do not have detailed code descriptions. As such, payers have relied on traditional practice standards that were available at the time the codes were last reviewed. Historically, descriptions of VRA test procedures included both speech and tonal stimuli as part of the test protocol. In contrast, CPA test protocols included tonal stimuli but did not include speech stimuli.
If a clinician completes CPA testing and performs speech measures as part of the evaluation, then the clinician can also report a code that best describes the speech measure—such as speech threshold audiometry (92555), select picture audiometry (92583) or speech audiometry threshold with speech recognition (92556).
Can I use CPT code 92550 (Tympanometry and reflex threshold measurements) if I perform a 1000 Hz ipsilateral acoustic reflex screening along with tympanometry?
CPT has defined acoustic reflex threshold testing (92568 and 92550) as including both ipsilateral and contralateral acoustic reflex threshold measurements. There is no CPT code for acoustic reflex screening. Only the tympanometry code (92567) would be allowed in this instance.
If I perform threshold-search auditory brainstem response testing and auditory steady-state response testing on the same day, what procedures should I bill?
ASSR is considered to be a type of auditory evoked potential test and does not have a specific CPT code. The comprehensive auditory evoked potential code (92585) is the most appropriate code for billing ASSR at this time.
92585 is a session-based code; it can be billed only once per day, even if both ABR and ASSR testing are completed on that day. An extended service modifier (-22) could be considered when both ABR and ASSR are completed on the same day. Detailed documentation of the justification for the extended service should be included in the patient’s medical record.
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July 2014
Volume 19, Issue 7