Medical billing includes using a specific set of Current Procedural Terminology (CPT) codes to facilitate communication between insurance payers and healthcare practices. These 5-digit codes are a challenge for medical professionals because most physicians are unaware of the correct applications of CPT codes.
These issues affect all medical specialties, including ENT practices. We have decided to pick an ENT code and explain its appropriate uses for your understanding. You can easily bill CPT code 92557 with this helpful guide, where we will cover modifier usage as well as billing and reimbursement guidance.
CPT Code 92557 – Description
CPT code 92557 is an ENT code from the category of Audiologic Function Tests. Under this category, physicians usually evaluate an individual’s hearing ability and diagnose any potential hearing disorders.
This code represents a procedure in which the healthcare professional uses a range of tones with different intensities to test the patient’s hearing. The physician determines the softest level at which a patient can hear. Additionally, he assesses the patient’s capacity to repeat and identify terms they are familiar with. It entails using headphones to listen to a variety of words and tones and reacting when noises are identified.
CPT code 92557 is a global code that represents a comprehensive audiometry threshold evaluation and speech recognition test. These comprehensive tests include speech audiometry, which comprises speech reception thresholds (SRT) and word recognition (WR) testing, as well as air and bone conduction threshold testing.
Scenarios Where CPT Code 92557 is Applicable
The scenarios listed below can help you use CPT code 92557 accurately.
Possibility of Hearing Loss
Suppose an old woman in her late 70s visits the clinic because she is facing partial hearing loss. She cannot hear or comprehend a few words. Additionally, she has difficulty hearing in crowded environments where more than two people are speaking simultaneously.
To diagnose her hearing frequencies, the physician suggests a comprehensive test, including SRT and WR testing and air and bone conduction threshold testing. In this scenario, the physician may apply CPT code 92557 for reimbursement.
Routine Hearing Check-Ups
Suppose a man who has been suffering from partial hearing loss visits the clinic for a follow-up check-up after a few months. The audiologist performs speech recognition tests and a thorough audiometry threshold evaluation to assess his hearing health and determine whether or not there has been any improvement. He can apply CPT code 92557 for his services.
Noise-Induced Hearing Loss
Exposure to damaging, loud noises can cause noise-induced hearing loss (NIHL). Anyone can get it, and it could be either temporary or permanent. Nearly 26 million persons between the ages of 20 and 69 have irreversible hearing loss as a result of excessive noise exposure.
Suppose a 40-year-old man comes to your clinic with hearing issues. He informs the physician that he faces difficulty in hearing high-pitched sounds and distorted speech due to severe pressure in his ear. While telling the details, he also mentions that he works at the site where the machinery makes high and disturbing noises all day long.
The medical professional recommends a speech recognition test and an audiometry threshold evaluation to diagnose his suspected noise-induced hearing loss. In this situation, the healthcare provider should use CPT code 92557.
Applicable Modifiers for CPT Code 92557
You can apply the following modifiers to CPT code 92557:
Modifier 52
Modifier 52 notifies the payer of the Reduced Services. CPT code 92557 represents a comprehensive audiometric threshold evaluation, and speech recognition is intrinsically bilateral, involving examination of both ears. If you only evaluate one ear for any medical reason, you can append this modifier.
Modifier 59
You can append a modifier 59 with CPT code 92557 to denote that the service is different from previous audiological procedures performed on the same day. However, the National Correct Coding Initiative (NCCI) revisions may restrict the billing of some treatments on the same day. Therefore, it is vital to refer to the payer’s specific requirements (such as those of Medicare or private insurance) when appending modifier 59.
Modifier 76
Modifier 76 states that a treatment or operation was performed again on the same day after the initial procedure by the same physician. Hence, the physician can append modifier 76 to CPT code 92557 if he is repeating the process on the same patient and the same day due to a change in the patient’s condition or clinical issues.
Modifier 77
If another physician is performing the procedure on the same patient on the same day because of some unanticipated circumstances, you can add modifier 77 to CPT code 92557.
CPT Code 92557 – Billing & Reimbursement Guidelines
Let’s discuss some essential billing guidelines for CPT code 92557. These guidelines will protect you from potential claim denials.
Ensure Correct Use of CPT Code 92557
When filing claims, you must be aware of the nature and correct use of the code. For instance, some physicians bill threshold testing and speech recognition tests separately, which is unacceptable. You can not bill CPT 92552, 92553, 92555, or 92556 as a separate procedure on the same day as CPT code 92557 because all these codes are components of a comprehensive audiometry test.
Provide Supporting Documents
When physicians file a claim, they support their case with some documents. Hence, it is essential to append accurate and comprehensive medical records with the claim. These documents must support the medical necessity of the procedure with appropriate ICD-10 diagnostic codes. Furthermore, your documents must contain the date of service, the patient’s details, the provider’s signature, and the results of every test that was part of the thorough evaluation.
Append Appropriate Modifiers
It is essential to append the appropriate modifiers in special circumstances if you want to be paid accurately for your services. For example, CPT code 92557 is a binaural code, which means it reflects testing for both ears. Therefore, you cannot use LT and RT modifiers with this code.
Use It as a Bundled Code
CPT code 92557 is a bundling code that combines the comprehensive audiometry threshold examination and speech recognition test. This means that you cannot separately bill elements of speech audiometry threshold and word recognition tests (92556) and air and bone conduction threshold tests (92553) in a single session.
Follow Payer-Specific Policies
When billing for CPT code 92557, it is also crucial to check the payer’s guidelines because each insurance payer’s (including private insurance and Medicare) coverage, billing rules, and payment vary.
Conclusion
We believe we have covered almost every aspect of CPT code 92557. Since this code refers to a comprehensive test, you can safely refer to this code as an all-in-one bundle code. Additionally, it is a binaural code that does not require LT and RT modifiers. However, if, in certain situations, the procedure is performed on one ear, you must append modifier 52 to indicate reduced services.
However, you can turn to professional ENT billing services if you are still having trouble with CPT coding. These services will eliminate your billing issues, including document collection, claim completion, and submission to the appropriate payer.
