Coding 101: Be Mindful When Using Certain Codes



Author: Kim Cavitt, Au.D.


When billing services to payers, including but not limited to Medicare and Medicaid, it is important that audiologists actually performed the procedure billed and that the documentation in the medical record supports the provision of that exact procedure billed.

Some providers are using codes for infrequently used and/or older procedures such as binocular microscopy (92504), Bekesy audiometry (92560/1), loudness balance test (92562), tone decay (92563), short increment sensitivity test (92564), filtered speech test (92571), sensorineural acuity level test (92575) to represent other procedures which do not have a specific code. These codes represent specific procedures in their own right and should not be used to represent other procedures or services. These codes should ONLY be used when:
  • Physician ordered (if Medicare).
  • Medically reasonable and necessary for this specific patient.
  • The specific procedure the code specifically represents is actually performed on the patient.
  • The practice has the required equipment or test materials to complete the procedure billed.
  • The medical record includes documentation of the results of the procedure and its medical necessity for the patient.
If providers need to bill for procedures such a vestibular evoked myogenic potentials (VEMPs), video head impulse testing (VHit), speech in noise testing (Quick-SIN), sensory organization testing, auditory steady state response (ASSR) testing, high-frequency audiometry, Eustachian tube function testing, fistula testing, saccade testing, head shake testing, and/or removal of incidental (non-impacted) cerumen, 92700 is the most appropriate and only code to use to represent these procedures.

As 92700 is often denied by payers, it is important that advanced beneficiary notices be completed for traditional Medicare beneficiaries, that organizational pre-determination processes be completed for Medicare Part C (Advantage) members, and that notices of non-coverage be completed by private insurance and Medicaid beneficiaries. It is also important to collect payment, in full, on the date of service when 92700 is utilized. You may charge the patient your usual and customary fee.

Finally, it is important to note that, if an audiologist is a Medicare provider, their claims information for 2012-2014 is readily available to the public. The Wall Street Journal (http://graphics.wsj.com/medicare-billing/) created a public portal that provides access to claims data for every type of provider. The availability of this type of data makes it easy for individuals to analyze your claims data.

If you have any questions, please contact me at kim.cavitt@audiologyresources.com.    
Kim Cavitt, Au.D. was a clinical audiologist and preceptor at The Ohio State University and Northwestern University for the first ten years of her career. Since 2001, Dr. Cavitt has operated her own Audiology consulting firm, Audiology Resources, Inc. She currently serves on the State of Illinois Speech Pathology and Audiology Licensure Board. She also serves on committees through AAA and ASHA and is an Adjunct Lecturer at Northwestern University.