Pediatric Coding Alert

Hearing and vision tests are often conducted as part of preventive medical services. But does that mean that they cant be billed in addition to the preventive medical services codes (99381-99385, 99391-99395)? You can and you should bill themespecially the hearing screens, for which there are several specific codes. Will you get paid for them? That depends, as is so often the case, on your carriers policies about these tests. In most cases, the tests will be paidproviding you bill correctly for them. Here are the techniques used by our sources.

Billing Tips for Hearing Screens

The three main hearing screens used by primary-care pediatricians are CPT 92551 (screening test, pure tone, air only), 92552 (pure tone audiometry [threshold]; air only), and 92555 (speech audiometry threshold), says Susan Beam, CCC/A, audiologist with Genesis Health Care System at Bethesda Hospital in Zanesville, OH.

Here is how these two screens work: Pure tone (92551) means that the child has ear phones on and the tone is set at 25 decibels. Then the frequencies are changed, and you test how well the child hears at the different frequencies, Beam explains. The intensity (decibel level) doesnt change, but the frequency does. The threshold test (92552) involves changing both intensity and frequency. The frequency is set at four different levels, and then you see what the lowest level intensity is at which the child can hear (hence the threshold). Speech audiometry (92555) involves a machine which delivers word soundsagain it is a threshold test, and you see how low the intensity can be and still have the child recognize the sound.

How well do these codes pay? According to HealthCare Consultants of America 1999 Physicians Fee and Coding Guide, 92551 pays from $25 to $30, 92552 from $29 to $35, and 92555 from $20 to $26. Are they included in the preventive medical services exam? No way. You should be able to bill for these, without a modifier, and get paid. As Beam puts it, the only way primary care pediatricians will get paid for using these codes is to charge for themafter all, they are screening codes, meant for use for referral purposes. If they pass, thats great, she says. If they dont, that tells you to refer them for more testing.

You should use the same diagnosis code for the hearing test as for the preventive medicine visit: V20.2 (routine infant or child health check).

Note: You cannot bill for any audiologic function test if you are using a tuning fork or a whispered voice. These are considered part of the general otorhinolaryngologic services and are not reported separately, according to CPT.

Vision Screening Coding Tactics

Vision testing is a little more complicated. You cant bill for most of the vision screening done in a primary care pediatricians office. Most pediatricians use an eye chart with an instrument, a time-consuming procedure with a young child, and one that currently has no code. In CPT 2000, there will be a new code for vision testing, reports Bela Agarwal, senior health policy analyst for the American Academy of Pediatrics (AAP). The AAP fought long and hard for this code, so pediatricians should use it. Insurance companies should recognize it as a separate service once there is a separate code for it, instead of saying its included in the preventive medicine services visit. This code will not be for the wall chartit will be for vision screening with an instrument, such as the Titmus test. This is something the AAP has been trying to get for many years, notes Richard H. Tuck, MD, FAAP, founding chairman of the AAPs RBRVS-PAC. It takes a lot of time and work to do this test.

Michelle Barker, office manager for Pediatric Ophthalmology Associates of Columbia, OH, notes that there is good reason why pediatricians have a hard time coding for vision screening. Theres no code for these visual acuity tests, she says. We use HOTV testing. This involves showing a child a card with the letters HOTV on it. We cant code for that, she says. The Titmus vision test is used by many schoolsthe child puts his or her head up to a machine and reads lines. The result is the childs visual acuity. For very young children, pictures are sometimes used. None of this is currently billable, she says.

There is a test that primary-care pediatricians sometimes use that can be billed, however. Carol Gilchrist, RN, CMM, practice manager for Gilchrist and Galvin, a pediatric practice in Chelmsford, MA, uses 92285 (external ocular photography with interpretation and report for documentation of medical progress). This code can be used on children as young as 6 months, Gilchrist explains. The child sits on the mothers lap in a partially darkened room, and the doctor takes one picture with a Polaroid camera, and then a second, and then you get one picture with just the two eyes on it, she explains. The picture shows the red reflex in both eyes, if all is well. It takes different measurements and can tell you if theres a problem. Again, Gilchrist uses V20.2 for the diagnosis code, both for the vision test and the preventive medicine services.

This test, says Barker, is an excellent screening test for conditions such as strabismus. You can use 92285 even if there turns out to be nothing wrong, says Barker. Nine out of 10 of the referrals pediatric ophthalmologists get end up being fine, notes Barker. But the point of the screening tests is that they are sensitive enough to pick up even potential problems.

Note: Do not use codes such as 368.9 (unspecified visual disturbance) or 389.9 (unspecified hearing loss) for these screening tests, unless there is indeed a problem.