In a coding victory for audiologists, the ASHA Health Care Economics Committee (HCEC) negotiated three new Current Procedure Terminology (CPT)* codes for tinnitus assessment and central auditory function assessment, the first audiology codes to include time designations.
"The central auditory assessment procedure is a very significant part of the practice of audiology. This code was developed because audiologists could not access existing CPT codes for reimbursement," said Robert Fifer of the HCEC and ASHA advisor to the American Medical Association (AMA) Relative Value Update Committee's (RUC) Health Care Professions Advisory Committee (HCPAC). "The tinnitus code reflects a change in the state of the science of audiology. There are several forms of treatment available for tinnitus, but the evaluation process did not have an identifiable procedure code."
This coding advance represents almost two years of work by the HCEC, Fifer said, noting that the codes were developed in collaboration with other organizations representing audiology, including the American Academy of Audiology, to develop the language for the codes.
The Making of a Code
The HCEC realized there was a need for new CPT codes in audiology for both tinnitus assessment and central auditory function assessment during 2002. Gary Jacobson, professor and director of audiology services at Vanderbilt University's Bill Wilkerson Center for Otolaryngology and Communication Sciences, met with the HCEC and described the inadequacy of the codes for tinnitus assessment during a committee meeting at the ASHA Annual Convention. He had prepared the first draft of a proposal for the CPT Editorial Panel to add a new tinnitus assessment code.
The committee had also developed a proposal to revise the central auditory function assessment code with two codes that would allow accurate reporting and reflect actual practice. The proposals were finalized and submitted to the AMA CPT Editorial Panel.
Fifer and Thomas Rees, vice chair of the HCEC, successfully presented and defended the three proposed procedures before the CPT Editorial Panel during their February 2004 meeting. The CPT coding system, developed by the AMA, is mandated by the federal government for use in all Medicare billing and contains approximately 8,000 procedure codes.
As with all new CPT code proposals, it was necessary for the HCEC to develop a vignette for each code describing the clinical details for a typical patient who requires the diagnostic services. Using the vignettes as a reference point, Fifer and Rees met with the AMA RUC HCPAC and successfully described time involved with the procedures as well as the equipment and supplies necessary to perform them.
Coding Guidance
The 2005 Medicare Physician Fee Schedule (MPFS) will include the three procedures and their reimbursement rates. The MPFS is expected in early November 2004.
The new codes and descriptors, effective Jan. 1, 2005, are as follows:
-
92620: Evaluation of central auditory function, with report; initial 60 minutes
-
92621: Each additional 15 minutes
-
92625: Assessment of tinnitus (includes pitch, loudness matching, and masking)
The guidance with the central auditory function codes in the 2005 CPT Manual is "Do not report 92620 or 92621 in conjunction with 92506." (The 92506 code is untimed for the "evaluation of speech, language, voice, communication, auditory processing, and/or aural rehabilitation status.")
Guidance regarding tinnitus assessment states that the loudness balance test (92562) cannot be billed on the same day as 92625.
The central auditory function codes are the first to include time designations. Specific rules issued by the Centers for Medicare and Medicaid Services (CMS) are for use of 15 minute codes:
-
> 8 minutes and < 23 minutes is billed as one 15-minute code
-
> 23 minutes and < 38 minutes is billed as two 15-minute codes
-
> 38 minutes and < 53 minutes is billed as three 15-minute codes
The CMS rule applies specifically to Medicare services but the rule has been adopted by many state Medicaid programs and private health plans.
"The development and refinement of codes is an ongoing process, but because it is a labor-intensive effort the HCEC can only work on a few codes at a time," Fifer noted. "Right now, work is underway on codes for aural rehabilitation as well as revision of the current code for voice evaluation with instrumentation, to refine and improve the code so that we can keep it available for speech-language pathologists."
The HCEC continues to seek suggestions from members regarding needed procedure codes. Contact Steven White at swhite@asha.org if you have any recommendations. For more information on the CPT codes, contact Mark Kander at mkander@asha.org.
* CPT © 2004 American Medical Association. All Rights Reserved.