Question
According to Otolaryngology Coding Alert (Vol. 9, No. 11, 2007), CPA (Conditioned Play Audiometry) and VRA (Visual Reinforcement Audiometry) should not be coded with 92552 or 92557 because CPA and VRA are substitutes for 92557. The article explains that "codes 92552 and 92579 measure the same thing and if a patient is able to participate in pure tone audiometry, VRA wouldn't be necessary." It goes on to say that "if the patient can repeat the words back to the audiologist, there would be no need to try to get a response any other way", but I had seen information in the past contradicting this. Can you clarify if the codes for CPA and VRA can be used with 92552 or 92557 or not? Thank you in advance.
Answer
The controversy focuses on the belief by some that 92579 and 92582 are method codes that should be reported in addition to 92552 or 92557. In fact, 92579 represents the audiogram that has been obtained using visual reinforcers to maintain the child's participation. CPT code 92582 is a legacy code, meaning that it has been around since before 1988. But the modern day valuation reviews for this code also have it as establishing the audiogram using play audiometry techniques.
In accordance with the rules of the AMA, each CPT code must represent an independent procedure that neither overlaps nor serves as an add-on code to any other code - unless the particular CPT code is particularly designated as an add-on code or a code to be billed in conjunction with another procedure. CPT codes 92552 and 92557 often represent efforts to obtain an audiogram using "standard audiometric techniques" generally interpreted to mean button-pushing or hand-raising. In similar manner, 92579 is a self-contained procedure code indicating efforts to obtain an audiogram using localization or lateralization and visual reinforcers. The same principle applies to 92582 for conditioned play audiometry.
The one tidbit that you need to know regarding 92579 and 92582 is that a speech detection threshold is included in the valuation of 92579 but not for 92582. That means if you do conditioned play audiometry and obtain a speech threshold, you can report code 92555 (SRT/SDT only) or 92556 (SRT/SDT plus discrim) in addition to 92582.
Robert C. Fifer, Ph.D. is currently the Director of Audiology and Speech-Language Pathology at the Mailman Center for Child Development, Department of Pediatrics, University of Miami School of Medicine. He received his B.S. degree from the University of Nebraska at Omaha in Speech-Language Pathology with a minor in Deaf Education. His M.A. degree is from Central Michigan University in Audiology. And his Ph.D. degree is from Baylor College of Medicine in Audiology and Bioacoustics. Dr. Fifer's clinical and research interests focus on the areas of auditory evoked potentials, central auditory processing, early detection of hearing loss in children, and auditory anatomy and physiology. He is the immediate Past-President of the Florida Association of Speech-Language Pathologists and Audiologists, a member of ASHA's Health Care Economics Committee, and 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. Additional responsibilities at the state level include serving as a consultant to the Florida Department of Health's Children's Medical Services and the audiology representative to the Genetics and Newborn Screening Advisory Council.
Robert C. Fifer, PhD
Director of Audiology and Speech Language Pathology at the Mailman Center for Child Development at the University of Miami
Robert C. Fifer, Ph.D. is Director of Audiology and Speech Language Pathology at the Mailman Center for Child Development at the University of Miami. Dr. Fifer represents ASHA on the AQC.
Related Courses
1https://www.audiologyonline.com/audiology-ceus/course/labyrinthine-reimbursement-for-hearing-aids-34378Labyrinthine Reimbursement for Hearing Aids: Navigating the PuzzleThis course will discuss factors affecting hearing aid reimbursement including the influence of insurances/HMOs, government regulations and corporate structures. Pro's and con's of billing models will also be discussed.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comLabyrinthine Reimbursement for Hearing Aids: Navigating the PuzzleThis course will discuss factors affecting hearing aid reimbursement including the influence of insurances/HMOs, government regulations and corporate structures. Pro's and con's of billing models will also be discussed.34378OnlinePT60M
This course will discuss factors affecting hearing aid reimbursement including the influence of insurances/HMOs, government regulations and corporate structures. Pro's and con's of billing models will also be discussed.
2https://www.audiologyonline.com/audiology-ceus/course/understanding-privilege-for-healthcare-professionals-36096Understanding Privilege, for Healthcare ProfessionalsSystems of privilege have created a wide division of inequality. This course will help hearing care professionals identify their privilege and determine how to make a difference in their places of employment.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comUnderstanding Privilege, for Healthcare ProfessionalsSystems of privilege have created a wide division of inequality. This course will help hearing care professionals identify their privilege and determine how to make a difference in their places of employment.36096OnlinePT60M
Systems of privilege have created a wide division of inequality. This course will help hearing care professionals identify their privilege and determine how to make a difference in their places of employment.
3https://www.audiologyonline.com/audiology-ceus/course/creating-leadership-in-audiology-through-37632Creating Leadership in Audiology Through a Mentoring CircleThere are so many components to quality patient care that it is challenging to “master” them all. What if you could come together with other professionals who possess knowledge or experience that could help you or your practice? There are a number of veteran audiologists as well as rising professionals who have wisdom, qualifications, narratives, and unique journeys to share. The purpose of this talk is to rethink the traditional mentor/mentee vertical relationship and explore collaboration in the form of circle…where all professionals, regardless of age or experience, learn from each other.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comCreating Leadership in Audiology Through a Mentoring CircleThere are so many components to quality patient care that it is challenging to “master” them all. What if you could come together with other professionals who possess knowledge or experience that could help you or your practice? There are a number of veteran audiologists as well as rising professionals who have wisdom, qualifications, narratives, and unique journeys to share. The purpose of this talk is to rethink the traditional mentor/mentee vertical relationship and explore collaboration in the form of circle…where all professionals, regardless of age or experience, learn from each other.37632OnlinePT60M
There are so many components to quality patient care that it is challenging to “master” them all. What if you could come together with other professionals who possess knowledge or experience that could help you or your practice? There are a number of veteran audiologists as well as rising professionals who have wisdom, qualifications, narratives, and unique journeys to share. The purpose of this talk is to rethink the traditional mentor/mentee vertical relationship and explore collaboration in the form of circle…where all professionals, regardless of age or experience, learn from each other.
4https://www.audiologyonline.com/audiology-ceus/course/using-patient-reported-outcome-measures-35841Using Patient-Reported Outcome Measures (PROMs) to Improve Patient-Clinician Communication and Enhance Treatment EfficacyDue to the recent increased focus on providing patient-centered healthcare, use of patient-reported outcome measures (PROMs) have become an essential component of assessing whether the services provided improved patients’ health and sense of well-being. This course will discuss the role of PROMs in healthcare and how using these measures in clinical practice can enhance treatment efficacy, improve patient-clinician communication, and assist clinicians in providing better person-centered care.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comUsing Patient-Reported Outcome Measures (PROMs) to Improve Patient-Clinician Communication and Enhance Treatment EfficacyDue to the recent increased focus on providing patient-centered healthcare, use of patient-reported outcome measures (PROMs) have become an essential component of assessing whether the services provided improved patients’ health and sense of well-being. This course will discuss the role of PROMs in healthcare and how using these measures in clinical practice can enhance treatment efficacy, improve patient-clinician communication, and assist clinicians in providing better person-centered care.35841OnlinePT60M
Due to the recent increased focus on providing patient-centered healthcare, use of patient-reported outcome measures (PROMs) have become an essential component of assessing whether the services provided improved patients’ health and sense of well-being. This course will discuss the role of PROMs in healthcare and how using these measures in clinical practice can enhance treatment efficacy, improve patient-clinician communication, and assist clinicians in providing better person-centered care.
5https://www.audiologyonline.com/audiology-ceus/course/salary-negotiations-32770Learn to Earn the Salary You Deserve: Negotiating Like a BossThe ability to negotiate your income displays immediate knowledge and confidence in your skillset and worth. In this course, we will examine a revenue and pay justification method to put into place as audiology business owners, employers, and employees.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comLearn to Earn the Salary You Deserve: Negotiating Like a BossThe ability to negotiate your income displays immediate knowledge and confidence in your skillset and worth. In this course, we will examine a revenue and pay justification method to put into place as audiology business owners, employers, and employees.32770OnlinePT60M
The ability to negotiate your income displays immediate knowledge and confidence in your skillset and worth. In this course, we will examine a revenue and pay justification method to put into place as audiology business owners, employers, and employees.