ASHA Responds to Otogram Billing Issue

ASHA's Health Care Economics Committee recently took steps to address billing concerns for services when a professional is not present. Specifically, the committee responded to reports that some health care billing contains audiology procedure codes when an Otogram* is used. The Otogram* is described on The Hearing Health Network Web site as performing "automated comprehensive audiometry, tympanometry/acoustic reflex and otoacoustic emission." Its manufacturer claims that the procedures performed by the Otogram* are "reimbursable by Medicare and other insurers" and that the Otogram* does not require new Current Procedural Terminology (CPT) codes.

ASHA has initiated discussions with coding staff at the AMA CPT Committees and payer groups in order to provide accurate information about appropriate coding for automated procedures. We suspect that payers are unaware that bills received for testing services rendered with an Otogram* are not for services performed by trained professionals using standard audiometric equipment because the tests are reported with the audiology codes and, thus, the payers have no basis for questioning the billing. The CPT manual states that procedures or services are "*used to designate the services rendered by any qualified physician or other qualified health professional."

The Health Care Economics Committee emphasized that protocols that involve only a testing instrument without professional input in the execution of the procedure should not be reported using the current audiology code series. That is, the reimbursement rates used by payers like Medicare are based in substantial part on a professional's time and skill. Audiologists who have their claims denied because the third party payer has already reimbursed procedures performed by an Otogram* should contact the payer and describe the difference between the two types of services. The committee concluded that the Otogram* should be useful for screening such as that called for in the new Welcome to Medicare physical examination. For further information, please contact Steven White, Director of Health Care Economics and Advocacy, at swhite@asha.org or by phone at 800-498-2071, ext. 4126.