Medical Decision Making Credit for Ordering an Audiogram

Medical Decision Making Credit for Ordering an Audiogram

September 30, 2021

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?

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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