CODING AND REIMBURSEMENT | Communication with the Coding and Reimbursement Committee: How Members Contribute to Payer-Policy Advocacy

By Kate Thomas

This article is a part of the May/June 2017, Volume 29, Number 3, Audiology Today issue.

Many of you may be familiar with, or may have even used, the Academy’s e-mail box for submitting coding, reimbursement, and compliance-related questions. This centralized mailbox (reimbursement@audiology.org) allows the Academy’s Coding and Reimbursement Committee (CRC) to review and discuss all inquiries posed to the Academy. The CRC is able to research, discuss, and vet responses to questions received. Having a centralized system for answering questions serves many purposes. It allows the CRC to identify trends in coding and reimbursement, develop coding and reimbursement resources, and engage in advocacy with payers regarding concerning policies.

As a national professional association, the Academy cannot become directly involved or provide legal opinions for individual-level disputes regarding contracts between members and insurance providers. However, we can identify problematic payer policies that affect audiologists nationally, and work with payers to modify those policies. In the past year, the CRC has been active in monitoring, updating, and addressing both Medicare and private-payer policies based on member concerns.

On January 1, 2016, CPT codes 92537 and 92538 replaced CPT code 92543 (Caloric vestibular test, each irrigation, with recording). Shortly after the effective date for the new caloric codes, the Academy received numerous reports of denials from audiologists across the country. Audiologists reported that when they attempted to use the new codes, they were denied because the new codes did not appear on the Audiology Code List provided by the Centers for Medicare and Medicaid Services (CMS). The Academy investigated further, and reached out to CMS on behalf of audiologists to remedy this issue and add the new caloric codes to Audiology Code List. CMS did make the change, and the Academy subsequently contacted all of the Medicare contractors to ensure they were aware of the update in order to prevent further denials. Though this particular issue was the result of an administrative oversight and easy to remedy, the error caused many issues for providers. Being able to track member concerns and identify the underlying issue based on national member feedback, allowed the CRC to act quickly regarding this policy issue.