Important Coding Changes for 2016!

Two New CPT Codes (92537/8) Added for Caloric Testing for 2016
 
92537 and 92538 replace 92543 in 2016.
  • 92543 will be eliminated.
  • You do not bill multiple units.  
Codes:
 
92537: Caloric vestibular test with recording, bilateral; bithermal (i.e. one warm and one cool irrigation for each ear for a total of four irrigations)
  • Add -52 modifier if only perform three irrigations and -22 modifier if perform more than four irrigations                    
92538: Caloric vestibular test with recording, bilateral; monothermal (i.e. one irrigation in each ear for a total of two irrigations)
  • Add –52 modifier if only complete one irrigation  
Significant PQRS Changes for 2016 
 
There are SIX REQUIRED PQRS Measures for 2016.  
  • Measure #130: Documentation and verification of current medications in the medical record.
    • Applies to use of CPT codes 92541, 92542, 92543, 92544, 92545, 92547, 92548, 92557, 92567, 92568, 92570, 92585, 92588, and/or 92626, regardless of the diagnosis.
  • Measure #134: Screening for clinical depression and follow-up plan.
    • Applies to use of CPT code 92625, regardless of diagnosis.
  • Measure #154: Falls Risk Assessment
    • Applies to use of CPT codes 92540, 92541, 92542, and/or 92548, regardless of diagnosis.
  • Measure #155: Falls Risk Plan of Care
    • Applies to use of CPT codes 92540, 92541, 92542, and/or 92548, regardless of diagnosis.
  • Measure #226: Screening for Tobacco Use/Cessation
    • Apples to the use of CPT codes 92540, 92557 and/or 92625, regardless of diagnosis.
  • Measure #261: Referral for otologic evaluation for patients with acute or chronic dizziness.
    • Apples to use of CPT codes 92540, 92541, 92542, 92543, 92544, 92545, 92546, 92547, 92548, 92550, 92557, 92567, 92568, 92570, and/or 92575 when the patient is diagnosed with dizziness (R42) or BPPV (H81.11-H81.13).
Audiologists must report a positive action on 50% of all eligible Medicare Part B beneficiaries for all six of these measures to avoid a 2018 penalty.
  • Reporting a negative action is the same as not reporting at all.  
You can no longer appeal your 2016 (from 2014 reporting) PQRS penalties.
 
You can learn more specifics by viewing the ADA 2016 Update webinar at
http://audiologist.org/2016-coding-and-reimbursement-update and the Audiology Quality Consortium website at www.audiologyquality.org.
 
For questions, please contact Kim Cavitt, AuD at kim.cavitt@audiologyresources.com.