The use of computer-based equipment has become an essential part of the life of an audiologist. Computers and software technology have opened doors to allow us to do many things that could not be done 15 or 20 years ago. However, one of the key elements to using new technologies has been the ongoing application of professional expertise, clinical judgment, and ongoing interpretation of the test results. Sometimes we joke, tongue in cheek, that we are becoming superfluous and that the machines can do it all. A significant attempt to move in that direction has recently been encountered.
The Otogram™ is an automated device designed to perform comprehensive audiometry, tympanometry, acoustic reflex measurements, and otoacoustic emissions, all at the touch of a button. The software in this equipment executes a series of decision matrices to determine the next operational step. Of particular interest is the claim by the manufacturer that the procedures are reimbursable by Medicare and other insurers. In addition, the manufacturer claims that the Otogram™ is eligible for reporting the current list of CPT codes for each respective component of the test battery.
There is, however, a fallacy in their declarations regarding reimbursement. A major premise of the American Medical Association (AMA) in recommending reimbursement values to the Center for Medicare and Medicaid Services (CMS) focuses on the delivery of professional services, not automated services. When new procedures are presented to the Health Care Professions Advisory Committee, part of the AMA's Relative Value System Update Committee (RUC), great care is taken in delineating what is professional contact and delivery of service versus what is done via automated protocol. Specifically for audiology codes, approximately 95% of the value for each code is based upon the time a professional spends face-to-face with the patient. Equipment costs are counted as part of the reimbursement formula, but they are prorated for depreciation and the number of Medicare patients seen during the course of a week. As a result, even the most expensive equipment used by audiologists contributes a very small portion of the overall reimbursement for each code.
ASHA's Health Care Economics Committee (HCEC) has had numerous discussions on the issue of using current CPT codes for automated services without direct professional involvement. The determination by this committee, at this time, is that automated services do not qualify for reimbursement using the current CPT codes based on the valuation methodologies for these codes. ASHA's representative to the AMA for the RUC Health Care Professions Advisory Committee has placed this topic on the agenda for the February meeting with the goal of obtaining a more definitive and authoritative determination regarding appropriate reporting of CPT codes involving the use of automated instrumentation only.
One of the key issues for audiologists is what happens when a claim is submitted and denied because the service was previously reported using the Otogram™. If the audiologist knows that this occurred, it will be worthwhile for the audiologist to contact the third party payer to explain the difference in the provision a professional services as compared to an unattended, automated device. Particularly if the billing comes from a physician's office, there likely will be many occasions when third party payers have no means to know beforehand whether the reported CPT codes represent professional services or computer testing by the Otogram™. Only through communication will they learn the difference.