Coding Strategy

Look for a physician order for diagnostic audiology tests.

If you thought CMS’s May transmittal on coding for audiology services was the last word on the subject, think again. On July 23, the agency rescinded the May directive and issued new guidance that should help clarify any audiology billing issues you may have.

Transmittal 129 not only breaks down how you’ll report audiology services, but also defines what comprises these services.

Who qualifies: According to the transmittal, “the term ‘audiology services’ specifically means such hearing and balance assessment services furnished by a qualified audiologist as the audiologist is legally authorized to perform under state law.” When CMS documents refer to “audiology services,” it’s understood that this term applies to services “furnished by an audiologist, physician, nonphysician practitioner, or hospital,” the transmittal says.

Incident to clarification: Because audiological diagnostic testing is designated by CMS under the benefit “other diagnostic tests,” you cannot report these tests as incident-to services. Orders Are Important Like other diagnostic tests, Medicare requires a physician or nonphysician practitioner (NPP) to order diagnostic audiology services. “If a beneficiary undergoes diagnostic testing performed by an audiologist without a physician order, the tests are not covered even if the audiologist discovers a pathologic condition,” the Medicare transmittal notes.

In cases where the physician or NPP orders diagnostic audiology services but does not indicate which specific tests to perform, “the audiologist may select the appropriate battery of tests,” CMS notes in the directive.

Resources: Medicare transmittal.

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Written by Torrey Kim, MA, CPC, Part B Insider, 2010; Volume 11, Number 27.

Image by Stephen Woods.

You have two options depending on how the physician performed the procedure.

Question: Our orthopedist administered a hip injection under fluoroscopy. Can I report both codes?

Wyoming Subscriber

Answer: You can code both the injection and fluoroscopy, but the correct choices depend on how your physician completed the procedure.

Option 1: If your orthopedist injected radiopaque dye and performed the arthrography concurrently, code the procedure with 27093 (Injection procedure for hip arthrography; without anesthesia).

Option 2: If he completed the guidance and injection as separate procedures, submit 20610 (Arthrocentesis, aspiration, and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) for the injection. Include 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) for the fluoroscopic guidance.

Remember to append modifier 26 (Professional component) to 77002 because your physician performed the service but doesn’t own the fluoroscopy equipment.

SI change: If the physician injects the sacroiliac joint instead of the hip joint, choose either 20610 (Arthrocentesis, aspiration, and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) or 27096 (Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid).

@ Orthopedic Coding Alert. Editor: Leigh DeLozier, CPC

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Plus: You can now download a list of all practitioners who can order/refer.

If you’ve been confused about how to report low-level hospital visits now that consult codes are gone, you aren’t alone. CMS intends to tackle this problem by issuing more specific guidance on the topic in the near future.

That’s according to a Feb. 2 CMS-sponsored Physicians, Nurses, and Allied Health Professionals Open Door Forum, where one practice asked the CMS reps when the agency plans to issue instructions on how to report initial hospital visits when the documentation doesn’t meet the criteria for the lowest level visit, a 99221.

CMS is currently working with the medical community to create such guidance, which will “hopefully be out shortly,” noted CMS’s Whitney May during the call.

One caller indicated that her MAC (WPS Medicare) instructed her to use the unlisted E/M code 99499 when the visit doesn’t meet the criteria of 99221 — but the MAC also said …

it would be inappropriate to report a subsequent care code prior to an initial care code.

That interpretation basically says “that if you don’t meet the initial care code, you have to bill unlisted, but the next day if you don’t meet the initial care code you still can’t bill a subsequent visit because you haven’t billed an initial hospital care code, so you have to bill another 99499,” the caller said. “I understand you’re working on creating guidance on this issue, but what do we do today?”

A CMS rep. advised the caller to follow local contractor guidance until CMS is able to issue a more detailed update. “We’ve been working closely with the medical community to try to develop very clear instructions for how to address this particular situation as well as some other questions that have come to us, and we are very close to having that information completed,” the CMS representative said. “We want to be very sure when we’re putting out information that we’re putting it out only one time and that it’s understood by everyone - so that should be coming out very soon.”

When asked whether the guidance would be issued in “days, weeks, or months,” the CMS rep responded only that CMS is doing its best “to get it out as soon as possible.”

Look for NPI List on CMS Site

CMS also addressed the fact that it had previously committed to sharing a list of all physicians and non-physician practitioners who are eligible to order and refer, and that list is now available on the Medicare provider enrollment web page at www.cms.hhs.gov/MedicareProviderSupEnroll, said said Patricia Peyton from CMS’s provider supplier enrollment office, during the call.

Once on the Web site, click on “ordering and referring report.” The .pdf file includes about 800,000 practitioners, their NPI numbers, and their last and first names.

Phase two of the ordering and referring edit starts on April 5, “and what happens then is every claim for an ordered or referred service, when it goes to be processed, if that ordering or referring provider does not pass the two edits, which are to have a current enrollment record and to be of the type that can order and refer,” then that claim will be rejected, Peyton said.

If you review the file and you don’t find your name but think you should be there, “contact your Medicare enrollment contractor,” she indicated.

One caller said that their organization submitted an application for a new provider, but was concerned that any services the provider orders during that period (such as diagnostic lab, radiology, or DME items) will be denied while CMS is waiting to process the certification application.

“We know that the applications can’t be processed overnight,” Peyton said. Once the physician is in PECOS, that supplier can resubmit the claim. “The supplier is not going to look at the date the provider enrolled, as long as the provider’s on the PECOS file that the claims processors use, and everything else is ok with the claim, the claim will then be paid.”

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