A patient presents with a referral from internal medicine with a diagnosis of R42 (dizziness and giddiness). The audiologist performs, among other tests, a comprehensive audiology evaluation (92557).
CPT code 92557 is included in:
- Measure #130: Documentation and Verification of Current Medications in the Medical Record
- Measure #226: Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention
- Measure #261: Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness
Because R42 is included in Measure #261, report the code that best matches the action taken on that date of service; reporting G8858 will not be included in your PQRS reporting and the penalty will not be averted.
- G8858, referral to a physician for an otologic evaluation performed, if you are referring to this patient to an otorhinolaryngologist, or
- G8857, patient is not eligible for referral for otologic evaluation measure (e.g., patients who are already under the care of a physician for acute or chronic dizziness), if you are referring this patient to their referring primary care physician or to their referring ENT
In addition to reporting on measure #261, you would also report on measures #130 and #226 as determined by the patient visit, for a total of 3 measures.
It is the combination of the CPT code and the ICD-10 codes, R42 or H81.11 (BPPV, right ear), H81.12 (BPPV, left ear) or H81.13 (BPPV, bilateral) that triggers the patient eligibility for reporting, not the measure description.