by Thomas Rees and Steven White
Many audiologists have had problems obtaining reimbursement for services involving tinnitus assessment procedures. This column describes the current state of affairs with tinnitus reimbursement and explains the new Current Procedural Terminology (CPT™)* code that will take effect in 2005. The code is the result of efforts by ASHA's Health Care Economics Committee (HCEC).
Q: What are the diagnostic codes for tinnitus?
A: The International Classification of Diseases, 9th edition, Clinical Modification (ICD-9-CM) codes for tinnitus are 388.30 tinnitus, unspecified; 388.31 subjective tinnitus; and 388.32 objective tinnitus.
Q: What CPT codes are now used?
A: Current CPT codes do not include components of the comprehensive tinnitus evaluation beyond the basic audiologic assessment. Some audiologists have used CPT code 92557 (comprehensive audiometry) with the modifier -22 for the tinnitus evaluation component (i.e., 92557-22). The use of the modifier -22 (unusual procedural services) designates that the service provided is greater than the usually provided service for the listed procedure. Other audiologists have used hearing aid codes found in the Healthcare Common Procedure Coding System (HCPCS). Some have used the aural rehabilitation code, CPT 92506 (evaluation of speech, language, voice, communication, auditory processing, and/or aural rehabilitation status) and others have tried using the CPT code 92700 (unspecified service) to report the tinnitus assessment procedures. In spite of these attempts, most insurance carriers have chosen not to reimburse audiologists for tinnitus assessment procedures. The lack of a specific tinnitus CPT code has resulted in poor or no reimbursement for audiologists performing tinnitus assessments.
Q: What is the new code for tinnitus procedures that takes effect next year?
A: Beginning in 2005, audiologists will be able to use the new CPT code entitled, "Assessment of Tinnitus (includes pitch, loudness matching, and masking)." This new code will permit reporting the three major components of the tinnitus assessment procedure and all three components (pitch matching, loudness matching, and masking) must be used to properly bill this code.
Q: What are these tinnitus assessment components?
A: Pitch (frequency) matching is intended to match the stimulus closest in pitch to the patient's tinnitus. Loudness matching testing is performed to obtain loudness matches between the audiometric stimulus and the patient's tinnitus. Following this, the masking procedure involves determination of the minimum masking level (MML) and testing for tinnitus suppression (residual inhibition). If only one ear is tested using the tinnitus assessment procedure, the modifier -52 (reduced service) should be applied. This would also be the case when only part of the tinnitus assessment battery is utilized.
Q: Where will this new code be found in the CPT manual?
A: The new tinnitus code will be placed in the Special Otorhinolaryngologic Services Section, Evaluative and Therapeutic Services Subsection.
Q: What is this new code number?
A: We won't know the code number until the AMA publishes the 2005 CPT in late 2004. The new code will also be published in the 2005 Medicare Physician Fee Schedule. Further information regarding the assessment of thetinnitus CPT code will be discussed as soon as the final 2005 Medicare Physician Fee Schedule is published or the 2005 CPT is released, whichever occurs sooner.
Q: How was this new code achieved?
A: Following a request by ASHA member Gary Jacobson, in 2003 ASHA's Health Care Economics Committee (HCEC) submitted a request to the American Medical Association (AMA) CPT Editorial Panel for a tinnitus assessment code. The panel approved the procedure in February 2004 and shortly afterward HCEC addressed the AMA Resource-Based Relative Value Scale Update Committee regarding the time and resources necessary to perform the tinnitus assessment procedures. These recommendations were subsequently approved and will be finalized in the 2005 Medicare Physician Fee Schedule published by the Centers for Medicare and Medicaid Services.
Tom Rees, an audiologist, is a member of ASHA's Health Care Economics Committee. Steven White, also an audiologist, is ASHA's director of health care economics and advocacy. Contact him at swhite@asha.org for more information.
* CPT © 2004 American Medical Association. All rights reserved.