May 14, 2002 Feature

Bottom Line: Coding Options for Central Auditory Processing

If you have ever seen a client struggle to distinguish speech in background noise, maintain focus over time, recall short-term memories, or hear the differences between sounds, then you may have encountered an individual with an auditory processing disorder (APD).

For decades, individuals with APD were improperly diagnosed as having hearing loss, attention deficit/hyperactivity disorder, and autism (Bellis, 2002). An accurate diagnosis of an APD is essential to ameliorate future misdiagnoses and to ensure that those with APD receive appropriate treatment. A central auditory processing (CAP) evaluation will determine if an APD exists and, if so, describe its parameters.

It is imperative that the client and/or family review their health plan and request clarification in writing of the coverage policy pertaining to audiology and speech-language pathology services. You can assist families in obtaining reimbursement by requesting prior authorization from the health plan. This involves providing the health plan with an explanation of the Current Procedural Terminology (CPT) and International Classification of Disease (ICD-9-CM) codes you intend to submit for reimbursement (see box below for relevant CPT codes).

CPT Codes

CPTDescription2002 Medicare Average
92506Evaluation of speech, language, voice, communication, and/or auditory processing (includes aural rehabilitation status$94.84
92589 Central auditory function test(s) (specify) $20.27
92571 Filtered speech test $14.48
92572 Staggered Spondaic Word Test $ 3.26
92576 Synthetic Sentence Test $16.65
92557 Comprehensive audiometry threshold evaluation and speech recognition $44.53
92567 Tympanometry $19.91
92568 Acoustic Reflex Testing $14.12
92569 Acoustic Reflex Decay Testing $15.20


An audiologist performing a CAP evaluation could code in one of two ways depending on the whether or not a speech-language pathology evaluation is also performed. Speech-language pathologists performing CAP evaluations typically would use 92506 for the evaluation and ICD-9-CM 784.60 for the diagnosis.

If both an audiologist and an SLP perform portions of the CAP evaluation and submit claims using 92506, the health plan will reimburse only one instance of 92506. Obtaining prior authorization can help reduce denials by helping the health plan understand that audiologists perform the auditory processing segment of 92506 and SLPs perform the speech-language segment.

Scenario #1—Use of test battery code

92557 Comprehensive audiometry threshold $44.53
92567 Tympanometry $19.91
92568 Acoustic Reflex Testing $14.12
92569 Acoustic Reflex Decay Testing $15.20
92506 Evaluation of speech, language, voice, communication, and/or auditory processing $94.84
Total $188.60

CPT 92506, a code that represents a battery of tests, has a higher work value (i.e., higher reimbursement rate) associated with it than CPT codes for individual CAP tests (e.g., Staggered Spondaic Word test).

An audiologist might also code using Scenario #2, to avoid problems with duplicating 92506. Medicare may not allow independent audiologists to bill for CPT 92506.

Scenario #2—Use of individual CAP test codes

92557 Comprehensive audiometry threshold $44.53
92567 Tympanometry $19.91
92568 Acoustic Reflex Testing $14.12
92569 Acoustic Reflex Decay Testing $15.20
92589 Central auditory function test(s) (specify) $85.08
($20.27 x 4)*
92571 Filtered Speech Test $14.48
92572 Staggered Spondaic Word Test $ 3.26
92576 Synthetic Sentence IdentificationTest $16.65
Total

$213.23


This total reimbursement rate is higher than for Scenario #1. In addition, there is no concern about 92506 being submitted to the health plan more than once.

*It is important to note that the health plan may only reimburse for one instance of 92589, which would reduce the total claim to $148.42.

Diagnosis Codes

There are a variety of ICD-9-CM codes that are appropriate when performing a CAP evaluation:

388.4 Other abnormal auditory perception
389.9 Hearing loss unspecified (If CAP results are normal)
389.12 Neural hearing loss
389.14 Central hearing loss
784.60 Symbolic dysfunction (i.e., cognitive impairment, language processing problems) This is commonly submitted by SLPs.
794.15 Abnormal auditory function study (if electrophysiological tests are performed)

Maureen Thompson is ASHA's director for private health plans advocacy. For more information on coding for central auditory processing evaluations, contact her through the ASHA Action Center at 800-498-2071, ext. 4431, by fax at 301-897-7356, or by e-mail at mthompson@asha.org.


  

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