Question
I have some confusion regarding the correct way to bill for OAE testing, comprehensive or unlimited?
Answer
This is something that continues to pop up, and your rule of thumb is - if you can count the number of frequencies, it's a screen or a limited. If you count the number of frequencies per octave, then it is a diagnostic. Now, the comprehensive versus limited are AMA terminology on how things have to be labeled. 92587, which is the Otoacoustic Emissions - Limited was designed from day one for newborn hearing screening. We don't use the word "screening" simply because screening has its own connotation, typically it's not reimbursable, but 92587 was developed on the basis of newborn hearing screen. But by AMA terminology, it has to use the word "limited."
Now also be aware that these codes came about in 1994, at least the diagnostic code did, and at that time the state of the science was to compare transient or click-evoked OAEs with distortion product OAEs or to do click-evoked at more than one intensity level or distortion product at more than one intensity level. That was then, this is now. Things have evolved to the point that we don't compare click-evoked and distortion anymore, or at least not very often, to say "I had to do this in order to learn about the status of the cochlea." Rather, what we do, what has evolved - and the literature supports this, is we are mapping the cochlea now, and that constitutes a comprehensive.
So if you do four points per octave, from 500 Hz through the limits of your equipment, then that is indeed a comprehensive. If you do six points per octave, that's really a comprehensive. I've come across a few that do ten points per octave. That's really a comprehensive. But if you count the number of frequencies, that's a screen or a limited. If you are looking up frequencies per octave over a very broad range, that can be justified as a comprehensive under the current use of OAEs.
Robert Fifer, Ph.D., is the Director of Audiology and Speech-Language Pathology for the Mailman Center for Child Development at the University of Miami School of Medicine. He is also an Audiology Online Contributing Editor in the area of Coding and Billing. He is the ASHA representative to the American Medical Association's Health Care Professions Advisory Committee for the Relative Value Utilization Committee in addition to being ASHA's representative to the AMA's Practice Expense Advisory Committee.
Editor's Note - The above is a partial transcript from the Coding and Billing QNA Live e-Seminar that was conducted on Audiology Online on June 27, 2007. (The recorded version is available here - Also the complete edited transcript is available here. The format of the session was different from most traditional presentations as we solicited questions ahead of time and also solicited questions during the event and had Dr. Fifer focus on answering those questions during the live session. We have published the transcript from the seminar in a semi-rough format to preserve the live feel from the session and to accelerate the publication timeline of this information to the Audiology Online readers. Submitted questions are bolded, followed by Dr. Fifer's response. Dr. Fifer is a frequent Contributing Editor for Audiology Online in this area, look for additional Coding and Billing QNA sessions on our home page in the near future. - Paul Dybala, Ph.D. - Editor
