Otolaryngolology coding : Four FAQs to help your Cochlear Implant Coding

Published: 06th May 2011
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Find out why physicians have limited use of available CPT codes

While reporting for audiologist's services, do not forget that Medicare prohibits audiologists from billing for treatment services. They're allowed to bill for diagnostic services only. But then otolaryngologists may bill for therapeutic services. For cochlear implant services, CPT manual lists 10 codes.

Do not rack your brains as yet. Thankfully you have ways to work within this guideline. Take a look at these FAQs and get to know how you should tackle that claim for hearing loss treatment.

What CPT codes do I have in my cache?

CPT lists 10 codes which you may use for cochlear implant services: 92506, 92507, 92601, 92602, 92603, 92604, 92626, 92627, 92630, 92633.

Once more, Medicare limits coverage of an audiologist's services to diagnostic testing only. What's more, speech language pathologists (SLPs) may only use 92506, 92507 and 92508 (Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals) for treatment services, including auditory rehabilitation, according to Medicare. This means that Medicare will not pay audiologists when they code 92506, 92507, or 92508. On the contrary, think of 92507 as an "umbrella" code that covers everything SLPs do. The otolaryngologist can report any of these codes.

What choices do I have besides 92507?

Depending on the type of cochlear implant service rendered by your doctor, you can check out using any of the 10 codes listed previously. For example, if the service involves cochlear implant fitting and programming, you would bill 92603 for patients older than seven years; 92601 for patients seven years and younger.

HCPCS' L codes too have a role to play for cochlear implant supplies. You'd report L8619 (Cochlear implant external speech processor and controller, integrated system, replacement) to code replacement, and L7500 (Repair of prosthetic device, hourly rate [excludes V5335 repair of oral or laryngeal prosthesis or artificial larynx]) to report repair services.

Key: Ensure you contact he payers to check which CPTs/HCPCS they will accept. Doing so could save you time in waiting for your payment.

What Medicare official directive should I refer to?

Medicare's specific policy on cochlear implant services appears on an article in MLN Matters, a publication of the CMS Medicare Learning Network, and describes Medicare coverage for CI services that became effective April 4, 2005.

As per the article, CMS will cover treatment of bilateral pre- or post-linguistic, sensorineural, moderate-to-profound hearing loss for individuals with hearing test scores equal to or less than 40 percent correct in the best aided listening condition on tape-recorded tests of open-set sentence recognition...in addition, the agency will cover cochlear implants of individuals with open-set sentence recognition test scores of greater than 40 percent to less than or equal to 60 percent correct, where the device was implanted in an acceptable clinical trial/study."

Do private payers follow Medicare rule?

Well some do, while others don't. Nevertheless, each patient's health plan has a specific policy regarding coverage that may differ from the others. Irrespective of the general policy of the health insurance carrier, you should check out the patient's contract to determine coverage.

You should also note that some states mandate cochlear implant (CI) coverage.

For more on this and for other specialty-specific articles to assist your otolaryngolology coding, sign up for a good medical coding resource like Coding Institute.

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