The content in the following Medicare FAQs was compiled in collaboration with the Academy of Doctors of Audiology (ADA), the American Academy of Audiology (AAA), and the American Speech-Language-Hearing Association (ASHA)
What is an ICD code?
The International Classification of Diseases (ICD) codes are numeric or alpha-numeric codes that are used to classify a diagnosis. The ICD-CM (Clinical Modification) is the version of ICD that is used in the United States.
The U.S. transitioned from ICD-9-CM (9th Revision) in October 2015 and is currently using the ICD-10-CM (10th Revision). Visit the Academy’s ICD-10 Web site for more ICD-10-CM resources, including a sample superbill template.
What ICD code do you report when results 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 choice would be to choose 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 will help paint a clear clinical picture of why the test(s) are being performed.
What is a CPT code?
Current Procedural Terminology (CPT®) codes (developed and maintained by the American Medical Association) are five-digit codes that designate a distinct test or therapeutic procedure. Each code has a description of the procedure or group of procedures that are included with the code. The procedure(s) included in the description are used to assess the value of that code.
What are some general principles of correct coding and billing for pediatric testing?
- Choose the CPT code that best represents the procedure that was performed. In other words, what type of testing technique was used to obtain your clinical findings?
- Most audiology CPT codes (with the exception of VRA) are valued based on the procedure being performed on both ears. If you are performing the testing on one ear, it may be appropriate to use a reduced service modifier (-52) to indicate that the entire procedure was not completed.
- General coding instructions indicate that, at times, it may be appropriate to append modifiers to services billed on a claim.
- The -52 modifier can be used for reduced services (e.g. unilateral testing as opposed to bilateral testing).
- The -22 modifier can be used when significantly extended services are provided that may require additional equipment (e.g. Auditory Steady State Response in addition to Auditory Brainstem Response testing).
- Be aware that some payers, including many state Medicaid programs, do not acknowledge all modifiers. In these cases, including a modifier with a code may delay the correct processing of the claim. If you utilize modifiers frequently for a particular service, it is best to check the payment policies of the payer.
Documentation in the patient’s medical record should support the reason that testing was completed and the reason why particular codes are being billed. Payers may deny payment if documentation is missing or is not consistent with the codes billed.
What is CPT code 92547 (Use of vertical electrodes)?
This add-on code has historically been utilized for the use of electrodes when performing electronystagmography (ENG). CPT code 92547 should be utilized for ENG only.
It is suggested you consult with commercial payors as to their guidance with videonystagmography (VNG) and the vertical channel as electrodes are not utilized with VNG. For use of vertical electrodes please consult the payors guidance as to the number of units allowed. The numbers of units may range from one unit per date of service to one unit for each test for which the electrodes were utilized.
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.
What are the specific requirements when performing and billing for otoacoustic emissions (OAEs)?
Otoacoustic emissions are not warranted in every test scenario. The documentation must substantiate the need for service.
CPT code 92587, distortion product OAEs (DPOAEs) or transient evoked OAEs (TEOAEs), limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies), with interpretation and report, is to be utilized when testing TEOAEs and/or DPOAES. The procedure involves testing 3-11 discrete frequencies (i.e., 3-11 frequencies per ear) in both the right and left ears. The interpretation cannot be merely a “pass/fail” but, instead, must clearly document the ear and frequency-specific test results. The reduced service modifier is indicated if only testing one ear.
CPT code 92588, Comprehensive diagnostic evaluation (cochlear mapping, minimum of 12 frequencies), with the report, is a more extensive OAE test that involves at least 12 frequencies in the right ear and 12 in the left and the interpretation of the test and the report in the patient’s record. Higher frequency resolution testing is recommended for applications requiring greater sensitivity to subtle changes in cochlear function. This includes, but is not limited to, ototoxicity evaluation (baseline and monitoring), hearing conservation, tinnitus evaluation, hereditary hearing loss evaluation, monitoring recovery from sudden hearing loss, and site of lesion evaluation. See also: CPT Coding for Otoacoustic Emissions FAQs
Must both ipsilateral and contralateral acoustic reflex thresholds be obtained to bill CPT codes 92568, 92550 and 92570?
Yes. To appropriately bill for acoustic reflex testing, the audiologist must perform both contralateral and ipsilateral reflexes. If you are only performing ipsilateral reflexes, you must append the -52 modifier to indicate reduced services. A reduced-services modifier is not required for incomplete stimulus frequencies, as long as there is a combination of the four test conditions that are necessary to obtain the complete diagnostic information. However, if one or more of the test conditions is not performed (eg, two contralateral simulations and one ipsilateral stimulation or two contralateral stimulations only), then use of modifier 52, Reduced services, would be appropriate to signify that the basic protocol for the procedure has not been altered, but the entire procedure has not been performed. (CPT Assistant, June 2009).
An ipsilateral acoustic reflex screening at 1000 Hz does not meet the coding criteria for 92568, because the protocol for this procedure requires obtaining the threshold level for the acoustic reflex and not simply observing the presence or absence of an acoustic reflex at a single intensity level.
What code can I use to bill for speech-in-noise testing (e.g. QuickSIN, HINT, BKB-SIN)?
Speech-in-noise testing could be included in Comprehensive Audiological Evaluation (92557) or as part of Speech Audiometry with Speech Recognition (92556) evaluation. Alternatively, it could be billed as an unlisted otorhinolaryngological procedure code 92700, with documentation & explanation of the procedure. Audiologists should consult payer guidelines for submitting the unlisted code.
CPT code 92700 should not be filed to Medicare if utilized as a predictor of hearing aid performance in noise.
Speech-in-noise testing should not be billed as a Filtered Speech Test (92571), as this code is one component of a comprehensive central auditory processing evaluation, and because filtered speech is NOT a speech-in-noise test.
What CPT code should I use to report vestibular evoked myogenic potentials (VEMPs)?
The American Medical Association (AMA) owns the CPT codes and definitions and publishes guidance regularly through the CPT Assistant. Per the March 2011 issue of the CPT Assistant, 92700 (unlisted otorhinolaryngological service or procedure) should be reported when VEMP testing is performed. There is no more specific code at this time to describe this testing. Audiologists should consult payer guidelines for submitting the unlisted code.
It is also important to read and review your Medicaid and third-party payer contracts to determine whether or not VEMPs are a covered procedure. State Medicaid programs may have specific coding and coverage guidance unique to the performance of VEMPs in a particular state.