Question
I work at a hospital where we do ABR for the purpose of identifying hearing loss in babies and young children. We often complete several ABRs, i.e. click, bone conduction, and tone burst ABR at several frequencies. Is it only possible to bill for one ABR for all this testing, if completed in one session?
Answer
The answer is yes. All of those activities do come under the heading of 92585, auditory evoked potentials.
Now, if you do this routinely, you need to bill 92585 by itself for that date of service. When we went back for the valuation review for that code, we tried to get more time built in, on the basis that these other activities are commonly done. But neither AMA nor CMS would accept that, and so it is what it is.
Now, if you typically only do a click ABR, and you look at that ABR and say, "This doesn't make sense. I want to do some tone burst ABR to validate and make more sense of this diagnostic."
So you go back through and do a tone burst, and your tone burst comes back really screwy. And you say, "This still doesn't make sense. I need to do bone." So you do a bone conduction ABR. If that is the exception and not the rule, then you can bill a dash-22 extended procedure suffix to your code, and then try to justify to the third-party payer why you want more money from them, why you took so much longer.
And you really need to do it on the basis of validity and interpretability. "On the basis that I did this, it didn't make sense. I did this to validate and cross-check, and that raised a new question that had to be answered by this third procedure. And by doing the combination, it extended the time MUCH greater than what I typically do for this type of evaluation."
But if you're in a pediatric center, like I am, and you typically do these things together as part of your routine, it is not appropriate to bill a dash-22 with a high number of cases, simply to say, "I'm doing this longer than most people do, therefore I need more money." If you do these things, and it's the exception and not the rule, then you could bill a-22 and submit a report to justify why the additional time.
Robert Fifer, Ph.D., is the Director of Audiology and Speech-Language Pathology for the Mailman Center for Child Development at the University of Miami School of Medicine. He is also an Audiology Online Contributing Editor in the area of Coding and Billing. He is the ASHA representative to the American Medical Association's Health Care Professions Advisory Committee for the Relative Value Utilization Committee in addition to being ASHA's representative to the AMA's Practice Expense Advisory Committee.
Editor's Note - The above is a partial transcript from the Coding and Billing QNA Live e-Seminar that was conducted on Audiology Online on June 27, 2007. (The recorded version is available here - Also the complete edited transcript is available here. The format of the session was different from most traditional presentations as we solicited questions ahead of time and also solicited questions during the event and had Dr. Fifer focus on answering those questions during the live session. We have published the transcript from the seminar in a semi-rough format to preserve the live feel from the session and to accelerate the publication timeline of this information to the Audiology Online readers. Submitted questions are bolded, followed by Dr. Fifer's response. Dr. Fifer is a frequent Contributing Editor for Audiology Online in this area, look for additional Coding and Billing QNA sessions on our home page in the near future. - Paul Dybala, Ph.D. - Editor
