Medical Decision Making Credit for Ordering an Audiogram

Medical Decision Making Credit for Ordering an Audiogram

September 30, 2021

Question:
My ENT doctor ordered an audiogram to be done by our audiologist. The doctor billed for the audiogram to a non-Medicare payor because the audiologist is not credentialled with that payor.  Can my doctor “get credit” for ordering and reviewing the audiogram when he chooses the E/M code level?  What happens when it’s a Medicare patient and the audiologist bills for the audiogram herself – what credit does the doctor get?

Answer:
Good questions and I know it can be confusing. Let’s look at your scenarios separately:

  1. Audiogram ordered and billed by the doctor: CPT guidelines are clear that if you order the test, and you bill for it, then you do not get Category 1 Data credit for ordering or reviewing.
  2. Audiogram ordered by the doctor and billed by the audiologist: Since the doctor is not billing for the test, s/he gets Category 1 Data credit for the test order. However, s/he does not receive Category 1 Data credit for the review because s/he ordered the test.

In neither situation does the doctor receive Category 2 Data credit for the independent interpretation for an audiogram because the audiogram code, 92557, does not have separate professional and technical components.

*This response is based on the best information available as of 9/30/21.

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