Billing Flashcards
billing basics
- medicare requires a physician order for coverage of audiologic and vestibular services
- the ordering physician must be enrolled with medicare although they can be a participating provider, non-participating provider, or opt-out provider
- a pt may not be balance billed for services denied by medicare
basic VNG billing code
92540
- basic vestibular eval: spontaneous nystagmus, positional nystagmus, OPK, smooth pursuit
- –note does not include calorics
basic billing code for spontaneous nystagmus test
92541
basic billing code for positional test with an minimum of 4 positions
92542
basic billing code for calorics
92543 can bill for each irrigation
basic billing code for OPK testing
92544
basic code for smooth pursuit testing
92545
basic code for CPD
92548
basic code for auditory evoked potentials for evoked response audio or testing of the CNS
92585
*debate as to whether or not VEMPs can be billed under this because they dont require the pt to have hearing but require auditory stimulation
billing for VEMPs
- ASHA states: no specific billing CPT code for VEMPS so should use 92700 which is unlisted otorhinolaryngologic service or procedure
- –not likely to be reimbursed
-22 CPT modifier
procedure was longer or more work than normal, a description of the need for extended services should accompany claim
-52 CPT modifier
abbreviated procedure such as if testing cold not be completed but was partially obtained
-59 CPT modifier
used in a situation where you are providing a bundled service such as 92540 but using 2-3 aspects of the bundled service
-26 CPT modifier
the professional component, the portion of diagnostic test that involves a physician’s work and the allocation of the practice expense
–TC CPT modifier
the technical component, for diagnostic tests, the portion of a procedure that does not include a physicians participation. the TC value is the difference between the global value and the professional component
