Hospital Based Outpatient Billing refers to the process of billing for items and services that are rendered in a facility that is designated as a hospital outpatient or clinic location. This is a national model of practice for large integrated health care delivery systems where the hospital owns the practice and employs the support personnel involved in patient care. Some audiology departments associated with hospitals submit claims as a hospital outpatient department.
Have additional coding, reimbursement or compliance questions? E-mail the Academy’s reimbursement mailbox. By submitting questions to the centralized mailbox, the Academy’s Coding and Reimbursement Committee (CRC) is able to review and discuss all inquiries posed to the Academy. This allows the CRC to research responses, identify trends in coding and reimbursement, develop coding and reimbursement resources, and engage in advocacy with payers regarding concerning policies.
Q: What code should be used to bill for a fistula test?
A: Based on your question it is assumed that you are using pneumatic otoscopy to obtain a fistula test. The CPT manual states "Diagnostic or treatment procedures usually included in a comprehensive otorhinolaryngoloc evaluation or office visit, are reported as an integral medical service, using the appropriate descriptors from the 99201 series. Itemization of component procedures (eg, otoscopy, rhinoscopy, tuning fork test) does not apply."
E/M services are grouped into several different categories and subcategories of services based on the setting (e.g., hospital or office) and type of service (e.g., initial or subsequent care). Within each category or subcategory of service, there are 3 to 5 levels of services that are specific to the category or subcategory of service. Medicare does not reimburse audiologists for Evaluation and Management codes, as covered audiology procedures for Medicare are defined as diagnostic services and not treatment services. This policy is also followed by a number of commercial insurance payers.
Comprehensive audiometric evaluation (air, bone and speech) is reported using CPT code 92557.
Q: What is the CPT code used for air and bone conduction threshold, SRT, and word recognition completed in one test session?
A: CPT code 92557 is the appropriate code when air and bone conduction thresholds (92553) and speech thresholds and word recognition (92556) are completed in one test session.
Balance billing is the practice of requesting payment from a patient for the remainder of the charge for an item or service that exceeds the amount allowed by the insurance plan.
Q: Is balanced billing permitted?
A: Many states have prohibitions against balanced billing that will be reflected in participation agreements with insurers or managed care networks. These agreements may contain such balanced billing prohibitions, also known as