Question
Can you talk about method codes?
Answer
Under the AMA Rules, there is no such thing as a method code. For example, if you billed 92557 (Comprehensive audiometry), you cannot also bill 92579 (VRA) to say "I did a diagnostic audiological evaluation using the method of visual reinforcement audiometry." Doesn't exist by AMA definition. Every code has to be a complete self-standing, non-overlapping procedure code. Here are some examples:
92557 - Comprehensive audiometry. Pure tone, air and bone, SRT and word recognition.
92579 -VRA. The audiogram obtained using visual reinforcement techniques.
92582 - Conditioning play audiometry. The audiogram obtained through the technique of condition play.
92553 - Audiometry, pure tone, air, and bone
As I mentioned in the example above. It is not appropriate to bill 92557 and 92579. Now, having said that, I've had several people email me and say, "Well I've been audited and I bill 57 and 79 all the time and nothing was said in the audit." Well, this falls under the heading of "Rather be Lucky Than Good" because you had an auditor who really did not understand our codes. It is not appropriate under AMA, nor is it appropriate under CMS guidelines to bill 57 and 79 together on the same date of service.
Now this person says, "I check the edits list and cannot find them to be exclusive of each other." That is true. It is possible sometimes that you would do a 57 and 79 completely repeating each procedure independent of the other. Or you might do a 53 using standard procedures, and then a 79 when things don't make sense for what you got for pure tone, air, and bone under the hand-raising technique.
Or, if you did conditioned play, 82, and you look at your results and say, "This really does not make sense. I got a full audiogram with pure tone, air, and bone, using conditioned play, but it really doesn't make sense to me. I need to cross-validate this using VRA." So you take the child in and do a complete VRA, 79, to recreate the audiogram as a cross-reference to what you got through conditioned play. Your documentation has to justify why you did one complete 82, and then why you went and did the other complete, 79. And there are certain occasions where it's justifiable on a case-by-case basis, but on a routine basis, it is not appropriate to bill 57 and 79 in combination or 57 and 82 in combination, because you are, in effect, double-billing for the same procedure.
The reimbursement level notwithstanding, that's a different story. But procedural-wise, it's not appropriate to bill the two together. And there is no such thing as a method code.
What is your expectation regarding coding for pediaudiology? Not just a quickie sound field screen. How do we indicate that we've done air conduction and bone conduction SATs, but also use VRA or conditioned play to obtain these results?
This is a similar question to the previous. Here's another tidbit for you. If you do a complete audiogram by air conduction and bone conduction, whether it be by sound field visual reinforcement or insert phones, if you use a VRA technique, you would have your choice of billing either 92579, for VRA, or a 92553, for pure tone, air, and bone. You can bill either one, and your results would justify billing either one, but it would not be appropriate to bill both.
That reminds me to tell you is that for 92579 (VRA), speech awareness threshold IS included in the valuation of that procedure. But for 92582, the conditioned play audiometry, speech testing is not included in that code.
So if you did conditioned play, got your audiogram, and then turned around and got your speech reception threshold, you can bill 92582 and then 92555, for speech threshold testing. But, as I mentioned previously, when evaluating children, it is appropriate to bill both 92579 and 92582 when you do bothly if you have justification for doing both.
Now, to expand on what I talked about earlier. For example, let me give you a situation I encountered about two or three weeks ago. I had a child, it was a low functioning five-year old that started off with play audiometry. There is no way this kid would do standard testing, so I started off with play audiometry. I got one pure tone threshold estimate, and then it was obvious that this kid just wasn't getting it. And so I stopped at that point and switched to 92579, and got pretty much a complete audiogram, using 92579.
Now, I did not bill 92582. And the reason why is because, even though I did some of that procedure, I did not get enough information for any clinical interpretation of my results. 92579 was what I billed because, with that procedure, I did get enough information to have a clinical assessment, a full interpretation of what does it mean.
So the guidance I would offer nd this is Fifer's experience and Fifer's opinion, as opposed to any official AMA ruling -- is if you get enough information for a clinical interpretation and then you find that you have to change procedures for some reason, then I would bill both of them. And I have done that. But I have also documented what caused me to want to change procedures to whereby I did both conditioned play and VRA. That doesn't happen very often.
I do not recommend a full regimen, routinely, of both VRA and conditioned play, simply because, once you have a lot of information from one, the information from the other really no longer falls under the heading of medical necessity. And my concern is a possibility of getting dinged on an audit, should someone come to pay you a visit.
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
