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.
