Question
I work in an outpatient hospital setting. Which of our audiology diagnostic CPT Codes can be broken down into and billed individually as technical and professional components?
Answer
In your particular setting as an outpatient hospital setting, none of your codes can be broken down into PC or TC components. And the reason why is because when you do your encounter form, you check off 92557, 92567, 9268, etc.
What you don't realize is that you come under a different reimbursement paradigm compared to a private practice office or a physician's office. Outpatient hospital settings fall into the rules for the Outpatient Prospective Payment System (OPPS). Under that system the CPT Codes are converted into Ambulatory Payment Codes (APCs), and what that means is that...let's take 92543-Caloric ENG. We normally bill that in units, and some parties pay $25 apiece for each unit, or some parties pay $15 apiece. Under OPPS, 92543 is reimbursed somewhere in the neighborhood of a flat $97 regardless of how many calorics you do and how many units you bill. It's a flat $97 and some change or thereabouts.
If I remember correctly, 92542 - the positional, gets converted to the same APC Code, and it's also reimbursed at a flat $97, the same reimbursement rate as caloric ENGs, as is optikinetic, as is all the rest. And so the CPTs are taken and converted into a different coding category for categorical reimbursement based upon the APC level. Because of that, you really can't break them down into TC and PC components just by virtue of the fact that you're an outpatient hospital setting and the rules that govern your reimbursement under the Outpatient Prospective Payment System (OPPS).
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
