Using 92552 Correctly To Avoid Fraud Charges

Using 92552 Correctly To Avoid Fraud Charges

Medical billing companies for audiology practices have long struggled over when to use the cpt codes 92552 versus 92551. 92551 means: screening test, pure tone, air only. 92552 means, pure tone audiometry (threshold); air only. You may be thinking, “What’s the difference?”. By definition, the difference between the two cpt codes is slight, but when medically billing these codes, it is huge. To avoid fraudulent charges, correct billing of 92552 is necessary.

First we will begin with what it means to use 92551 in medical billing. Simply put, an audiologist places headphones on a patient. Then the doctor sets the machine at a constant intensity while playing various frequency tones in each ear. This means the volume is the same and the pitch, whether it be high or low, varies. The patient then responds to the tones given.

92552 in medical billing is when the audiologist puts headphones on a patient . Then the machine, not only changes tones in frequency, but also changes intensity. The doctor records the very lowest intensity a person can hear at various frequency levels.

As you can see, there is a slight difference between 92551 and 92552 in medical billing. 92552 is more complicated because the frequency and pitch of the tones change. This more complicated procedure demands more money for reimbursement. If 92551 is performed, but when the claim runs through medical billing, it is charged as a 92552, this becomes fraud. It is fraud because a more complicated procedure is billed than was actually performed.

It is important to note that insurance companies as well as the federal government have no tolerance for fraud in medical billing. As stated earlier, the slight difference between 92552 and 92551 is small, but when medically billing these codes, the difference is astronomical.

View all Articles by: Melissa Clark, CCS-P