New and revised audiology billing codes are not uncommon, but their arrival can seem mysterious. Over the past few years, audiologists have seen several changes to Current Procedural Terminology (CPT®) codes for different vestibular and audiologic testing procedures. This year is no exception, as significant updates to the CPT code set went into effect Jan. 1, marking the first time that audiologists can bill for vestibular evoked myogenic potential (VEMP) testing with procedure-specific codes. In addition, changes to codes describing auditory evoked potential (AEP) testing more clearly define the spectrum of AEP screening and testing.
Inevitably, CPT code changes add work to the new year “to-do” list, including updating billing systems, checking with payers, and learning new code numbers and guidelines. But for all the headaches they may cause, changes to CPT codes represent more than just a new number. The journey from concept to implementation often takes years. It requires close collaboration among national organizations representing audiology and related specialties. It also requires input from practicing audiologists across the country and an investment of uncounted hours of volunteer work from a dedicated group of audiologists who are experts in the code development process.
A MULTI-YEAR PROCESS
The work that goes into CPT code changes is a complex process managed by the American Medical Association (AMA), which owns and maintains the CPT code set and recommends code values to the Centers for Medicare & Medicaid Services (CMS). Audiology organizations, including the American Speech-Language-Hearing Association (ASHA), and experts in the field must work together to identify and conceptualize needed changes that are in the best interest of the profession. To establish their clinical efficacy, they must demonstrate that proposed changes reflect current practice and describe distinct, well-defined procedures backed by peer-reviewed literature.
Once defined, CPT codes move to the valuation process, which ultimately informs the value of each CPT code paid under the Medicare Physician Fee Schedule (MPFS). At this stage, audiologists nationwide are asked to complete surveys that assess the time, intensity, complexity, and clinical skill needed to complete the procedures in question.
The survey data gathered from audiologists is vital. Without it, CMS and other payers can't fully understand the worth of audiologists’ work. The ASHA resource, “How a CPT Code Becomes a Code” provides more detail on this process, including the critical role audiologists play in determining the outcome (ASHA, 2017; https://bit.ly/2INidBa).
A MORE PRECISE CODING TOOLBOX
For 2021, that multi-year process resulted in seven new codes audiologists can add to their coding toolbox. AEP testing codes 92585 (comprehensive) and 92586 (limited) have been replaced with four new and more descriptive codes for automated screening of auditory potential with broadband stimuli (92560), testing for hearing status determination with broadband stimuli (92561), testing for threshold estimation at multiple frequencies (92562), and testing to evaluate neural conduction (92563). Three new CPT codes for VEMP testing allow audiologists to bill for cervical VEMP (cVEMP, 92517) and ocular VEMP (oVEMP, 92518) testing when performed alone, and oVEMP and cVEMP testing performed together on the same day (92519). ASHA's resource, “Audiology CPT and HCPCS Code Changes for 2021” provides additional information (ASHA, 2021; https://bit.ly/3lFBd2R).
ASHA expects the VEMP testing codes should help audiologists avoid the use of the unspecified procedure code, 92700, and the cumbersome paperwork and uncertain reimbursement that went along with it. Now more clearly defined, AEP testing codes should also help audiologists avoid coding confusion and reduce the potential for audit. And maybe just as importantly, the new codes affirm the ongoing collaboration among audiology groups to advocate on behalf of the profession.
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