Question
What's Medicare and other insurance companies doing about the Otogram?
Answer
Not a whole lot, and here's the reason why. Medicare does not like the Otogram. I have had many conversations with my contacts in Baltimore. They do not like the Otogram, and the reason that they don't like the Otogram has nothing to do with the reliability of the device, although that is part of it.
The reason why they don't like the Otogram is because our procedures are valued on the basis of personal delivery of professional services to every patient. They are not valued on the basis of machine delivery or machine gathering of information only. And so it violates the AMA Guidelines, it violates the Medicare CMS guidelines for reimbursement for those CPT Codes.
Here is one other little tidbit of information - Under the previous owner of the Otogram, in the small print in the literature it stated that these results must not be used for diagnostic purposes, which by definition stated on the literature advertising the Otogram, that would throw it into a screening realm, and screenings are not authorized reimbursement. So the Otogram technically is not authorized reimbursement. (As an updated note, an article appeared in the October issue of CPT Assistant - an AMA publication, stating that the Otogram should be reported under CPT code 92700 for all component procedures associated with that device.)
There have been some billings where primary care physicians go sky high with the Otogram. I do know a few of them have been visited by auditors, and I don't know the outcome of the audits, but Medicare is looking at it but only where things really look suspicious. They really have no other way of knowing right now, when a bill is submitted whether it came from an Otogram or a personal delivery of services, and that is what's stumping them in terms of doing anything about it at the present 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
