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National Correct Coding Initiative (NCCI) Payment Restrictions Lifted on Single Vestibular Codes-Effective October 1, 2010
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NO CHANGES IN AUDIOLOGY-RELATED CPT CODES FOR 2011
According to the recent E-Newsletter from the American Academy of Audiology, there are not any new CPT, ICD-9 or HCPCS codes for audiology in 2011. Congress passed a bill extending the current Medicare Physician Fee Schedule through December 31, 2011, thereby averting a 25% or greater reduction in reimbursement that was to take effect on January 1, 2011. The 2010 Medicare Physician Fee Schedule (MPFS) remains in effect until further notice.
It was also reported in the same E-Newsletter that CPT code 95992, Canalith Repositioning Procedure, returns to the 2011 MPFS as a stand-alone code. Since this is a non-covered Medicare procedure, “patients can be offered a voluntary Advanced Beneficiary Notice (ABN) to alert them of their financial responsibility to pay for the service” assuming they choose to have the procedure performed. (AAA E-Newsletter, January 5, 2011).
Please consult your Medicare contractor for additional information.
Since implementation, beginning this year, the American Academy of Audiology, the American Speech-Language-Hearing Association, the American Academy of Otolaryngology-Head and Neck Surgery, and the American Academy of Neurology, have diligently petitioned to lift the National Correct Coding Initiative (NCCI) edits that were incorrectly placed on the individual vestibular CPT codes 92541, 92542, 92544 and 92545. Given that the Centers for Medicare and Medicaid Services (CMS) directs NCCI, these edits were applicable primarily to Medicare beneficiaries. Together, these four codes comprise the new basic vestibular evaluation, CPT code 92540, and their descriptors are listed below. The NCCI edits, in their current state, preclude these codes from being filed individually if fewer than four of the tests are performed. Effective October 1, 2010, “if two or three of these codes are reported for the same date of service by the same provider for the same beneficiary, an NCCI-associated modifier may be utilized to bypass the NCCI edits.” The Academy will offer an update to members regarding any required modifiers. The effective date for outpatient facility services is also being clarified by NCCI. As of the effective October 1 date, the corrections to the descriptions of the codes will be reported as:
- CPT code 92540 Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording.
(Do not report 92540 in conjunction with 92541, 92542, 92544, or 92545)
- CPT code 92541 Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording.
(Do not report 92541 in conjunction with 92540 or the set of 92542, 92544, and 92545)
- CPT code 92542 Positional nystagmus test, minimum of 4 positions, with recording.
(Do not report 92542 in conjunction with 92540 or the set of 92541, 92544, and 92545)
- CPT code 92544 Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording.
(Do not report 92544 in conjunction with 92540 or the set of 92541, 92542, and 92545)
- CPT code 92545 Oscillating tracking test, with recording.
(Do not report 92545 in conjunction with 92540 or the set of 92541, 92542, and 92544)
These corrections are listed on the American Medical Association (AMA) Current Procedural Terminology site. Please direct questions to Debbie Abel, AuD, director of reimbursement and practice compliance, at 703-226-1024.
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