ENT medical billing, although relatively easy compared to other specialties, can become challenging for some procedures. Why? Because of complex bundling rules. The same procedures may have different CPT codes when combined with other services, whether minor or major. One such code is CPT code 92550.
The denial rate for claims with CPT 92550 is high, leading to significant revenue loss for ENT practices. That is why our billing experts at MediBillMD have created this guide, so you can keep denials at bay. In this guide, we will discuss everything you need to know about this code to file claims successfully. So, let’s start.
CPT Code 92550 – Description
CPT code 92550 is defined as:
“Tympanometry and reflex threshold measurements”.
As evident from the definition, 92550 represents two separate audiologic function tests that are bundled together. Tymanometry on its own is billed with CPT code 92567, and reflex threshold measurement, also called acoustic reflex testing, is billed with CPT code 92568.
However, if both of these services are provided on the same day, healthcare providers must use the bundle code – CPT code 92550 – for billing. In this scenario, these services cannot be billed separately.
CPT code 92550 is used for a complete check-up of the middle ear. But what exactly happens in each procedure? Let’s briefly discuss.
Tympanometry, or impedance testing, measures the compliance and mobility of the tympanic membrane and middle ear system by varying the air pressure in the ear canal. This test provides valuable information about middle ear function, eustachian tube patency, and middle ear pathology such as fluid accumulation or ossicular chain disruption.
The acoustic reflex part, on the other hand, evaluates the reflexive contraction of the stapedius muscle in response to loud sounds that are made with a probe. It involves testing of both ipsilateral and contralateral acoustic reflex thresholds.
Billers must always take into account the bundled nature of this code and the procedures themselves. Simple mistakes can lead to claim denials.
Scenarios Where CPT Code 92550 is Applicable
Explanation is not enough. To better understand how to use CPT code 92550 effectively, let’s discuss a couple of real-world scenarios in which it is applicable.
Otitis Media
CPT code 92550 is frequently used for diagnosing otitis media (middle ear infection). Suppose a patient visits an ENT clinic with ear pain and reduced hearing. How will the physician diagnose the condition? Well, the best way is to perform both tympanometry and acoustic reflex testing.
These two tests provide a comprehensive evaluation of the middle ear. Tympanometry detects the presence and amount of fluid in the middle ear through characteristic flat or negative pressure patterns. Meanwhile, the acoustic reflex may be absent or significantly elevated due to the dampening effect caused by middle ear fluid.
Eustachian Tube Dysfunction
Another use of CPT code 92550 is for detecting eustachian tube dysfunction (ETD). Patients experiencing ear pain, hearing fluctuation, or recurrent ear infections may have ETD.
But how can the ENT specialist confirm this diagnosis? The answer is via a combination of tympanometry and acoustic reflex testing. The combined testing allows the specialist to assess both the mechanical properties of the middle ear system and the integrity of the acoustic reflex pathway.
Applicable Modifiers for CPT Code 92550
You may append the following modifiers to code 92550 to increase coding specificity and the chances of collecting accurate reimbursements.
| Modifier | Description | Usage |
|---|---|---|
| 52 | Reduced Services | Use for reduced services, for example, when testing is performed on only one ear instead of both ears. |
| 59 | Distinct Procedural Service | Indicates a distinct service separate from other procedures performed on the same day. |
| 76 | Repeat Procedure by Same Physician | The same provider repeats the procedure on the same day. |
| 77 | Repeat Procedure by Another Physician | A different provider repeats the procedure on the same day. |
| AB | Audiologist | Service provided by an audiologist without a physician referral for non-acute hearing conditions. |
CPT Code 92550 – Billing & Reimbursement Guidelines
The following billing best practices and guidelines will help you prevent claim denials and collect accurate reimbursement for your combined tympanometry and reflex threshold testing (represented by CPT code 92550).
Obtain Pre-Authorization
In case of some insurance payers, you may need prior authorization before performing tympanometry and reflex threshold measurements (CPT code 92550). However, this is not a fixed rule. Therefore, you must check and confirm with the insurance payer before providing any services.
Prior authorization is especially essential when private insurance companies are involved. These companies mandate prior approval for many audiology procedures, particularly when performed in conjunction with other services or when multiple audiology visits are required.
Provide Complete Documentation
Like all other CPT codes, documentation is vital to prove the medical necessity of audiologic function tests represented by CPT code 92550. ENT specialists must maintain detailed records of all the essential aspects related to these tests, including symptoms, any prior medication, patient’s details, test findings, and treatment options. Without proper documentation, claims will be rejected, leading to financial losses.
Consider the Code’s Bilateral Usage
An important thing to note about CPT code 92550 is that it is a bilateral code. This means that the test is performed for both ears in the same session. So, separate billing for the other ear or appending modifiers LT and RT is not required. However, if for some reason only one ear is tested, use modifier 52 to indicate reduced services.
Wrapping Up
Let’s do a quick recap. CPT code 92550 is a bundled code. It combines tympanometry and acoustic reflex testing into a single code if both tests are performed on the same day. You must use the correct modifiers when needed to explain the circumstances in which these tests were performed to avoid denials.
Ready to optimize your revenue cycle? Our ENT billing services include implementing these strategies to help you maximize your CPT 92550 reimbursement collections.
