Assessing hearing in infants and young children is a routine part of many audiology practices and confusion abounds regarding the appropriate procedure code to report. The following questions and answers provide information about the valuation process for the procedures.
Q: When testing an infant using visual reinforcement audiometry [(VRA), CPT© 92579], or testing a child using conditioning play audiometry [(CPA), CPT 92582], is it appropriate to use separate codes for speech audiometry threshold (CPT 92555)?
When performing VRA, bill only code 92579. When performing CPA (92582), you can also bill for speech threshold (92555). Why? Because speech-awareness threshold is included as part of the CPT valuation for 92579, but 92582 represents only the audiogram obtained and does not include any speech testing.
The CPT helps describe a procedure or understand its features and a typical use of each code or procedure. The VRA includes a speech-detection threshold as an integral part of the procedure. VRA most often refers formally or informally to air-conduction threshold estimates because of the age, attention span, and typical fatigue level of the patient. On some occasions, however, bone conduction is obtained successfully using VRA. In that instance, either VRA or 92553 can be reported, but not both.
CPA also often serves as an estimate of air conduction threshold by virtue of the age, level of maturity, and stamina of the patient, who is usually a child. Speech-threshold measures here are not included in the vignette used to revalue the code, so reporting 92555 also should be acceptable. If you perform speech-threshold measures and also speech discrimination such as WIPI or NU-Chips, 92556 could be reported.
If bone thresholds are obtained, you can bill 92582 or 92553, but not both. And if you perform air- and bone-conduction measurements, speech thresholds, and speech discrimination, you meet the requirements to report 92557 even though the pure-tone information was obtained using play techniques.
Q: What code should I use if I perform sound-field VRA and then repeat testing with insert earphones?
When VRA was established as a procedure within the American Medical Association's CPT coding system, it was performed as a sound-field-only procedure with a speech-detection threshold as a cross-check. Many audiologists have moved to insert earphones in place of or in addition to sound field. If you obtain ear-specific threshold estimates using insert earphones and visual reinforcers, you meet the criteria for either pure-tone threshold testing (92552) or VRA (92579). If you use inserts and also do bone, you meet the criteria for pure-tone threshold, air, and bone (92553). You can choose which code to bill.
Consider the following to guide your choice. For which code have you met criteria? Will you use the sound field or insert earphone data to render a clinical assessment of the findings? An audiologist may start with a sound-field VRA to find a ballpark estimate of where to look and then insert earphones to find more precise threshold estimates per ear.
If that is done, consider billing 92552 because you are using the ear-specific pure-tone audiogram as the basis for interpretation. If you do bone and insert earphone AC measurements, consider billing 92553 even though a visual reinforcer was used to maintain the child's attention. However if you do sound-field testing and later in that session attempt to use insert earphones, finding perhaps a maximum of two or three thresholds before the child's attention evaporates, consider billing 92579. The sound-field data is more complete and more likely to be used for the clinical interpretation of the overall results.
Q: What are typical charges for these audiological procedures?
ASHA, like all professional associations, does not collect typical charge data because of the price-fixing implications of doing so. A public program such as Medicare uses the resource-based relative value scale (RBRVS) that assigns a relative value to each CPT procedure. The relative weighting factor (relative value unit or RVU) is derived from a resource-based relative value scale. The RBRVS divides each procedure into three RVU components:
- Professional—also known as "physician work" that encompasses time, technical skill, physical effort, stress, and clinical judgment on the part of the physician or other qualified health care professional
- Technical—also known as "practice expense" that includes overhead costs and non-physician medical staff time costs
- Professional liability—malpractice costs
These components are totaled to arrive at the CPT procedure RVU, and then multiplied by the annual conversion factor.
ASHA members also have access to a 2007 Milliman actuarial report that includes historic charges and reimbursed levels from private health plan carriers. For a copy of the report, contact your State Advocate for Reimbursement Network member or purchase the ASHA publication Negotiating Health Care Contracts and Calculating Fees.