Pediatric Coding Alert

Know which ones can be used as screening tools, and why.

Whether your pediatrician performs them as part of a preventive medicine visit or to test a patient with an underlying hearing problem, hearing tests and screens are a significant service in your pediatric practice. But no matter how familiar you think you are with them, they present their own unique set of challenges that can trip up even the most seasoned coder.

Want to get hearing screening coding right first time, every time? Read on, listen closely, and you will.

Know These Pure Tone, Air Only Tests Have Different Purposes

Chances are you know 92551 (Screening test, pure tone, air only) and 92552 (Pure tone audiometry (threshold); air only) pretty well. But do you know what they do?

The 92551 code is a screening test that is performed when the patient has no complaint. For example, it can be performed during a routine well-check such as 99381-99387 (Initial comprehensive preventive medicine evaluation and management of an individual ...) or 99391-99397 (Periodic comprehensive preventive medicine reevaluation and management of an individual ...).

Simply put, as Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians explains it, the test "identifies the presence or absence of a potential hearing problem." It is a hearing screening, Moore elaborates, "and is not used to determine the degree or type of hearing loss."  

On the other hand, 92552 is a diagnostic test that is used when a patient reports with a hearing problem. Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting, Inc. in Lansdale, Pennsylvania, notes that, as its descriptor implies, "the test attempts to determine the threshold of the patient's hearing by playing different frequencies at different volume levels to determine the lowest intensity of sound a patient can hear at different frequency levels."

The procedure, Moore explains, "provides a lot more information about the extent of the patient's potential hearing loss." This is why, Moore goes on, 92552 is used more for diagnostic than screening purposes. However, the American Academy of Pediatrics (AAP) does list it alongside 92551 for use as a possible hearing screening tool (Source: https://www.aap.org/en-us/documents/coding_factsheet_brightfuturespreventivemedicine.pdf).

Coding alert: Moore also notes that CPT^® guidelines specify that "both services include testing of both ears" and that you should use modifier 52 (Reduced services) "if a test is applied to one ear instead of two."

Know How to Apply the Results

If the child passes the screening as part of the well child exam, you would link it to Z01.10 (Encounter for examination of ears and hearing without abnormal findings). However, if the child fails it, you would link it to Z01.11 (Encounter for examination of ears and hearing with abnormal findings) and wait for your provider, or more likely, a specialist, to provide more specialized testing.

Know These Specialized Tests Can Also Be Screens

Other tests that your pediatrician could use will provide more precise information than 92551 and 92552, but they still, under certain circumstances, can be used as screens. Code 92567 (Tympanometry (impedance testing)), for example, is another test that determines the functionality of the eustachian tube and the middle ear. Despite that fact, the AAP does recommend that it, too, can be used as a hearing screen along with 92551 and 92552.

CPT^® also lists three otoacoustic emissions (OAE) tests for the inner ear:

• 92587 (Distortion product evoked otoacoustic emissions; limited evaluation ... 3-6 frequencies ... with interpretation and report),
• 92588 (... comprehensive evaluation ... minimum of 12 frequencies ... with interpretation and report), and
• 92558 (Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis).

OAE tests measure the quiet sounds produced when the hair cells in the inner ear vibrate. As this means that the patient does not have to indicate whether or not they perceive a sound, they are ideally suited to younger patients who are unable to verbally or visually communicate their ability to hear frequencies, which is necessary when 92551 and 92552 are used for screening purposes. This is why CPT^® Advisor states that, despite its widespread use as a screen, 92551 is not appropriate "to report hearing screenings performed on newborns and infants."

Know Your Payer's Preference

If your provider does use an OAE test for a screen, though, be warned: some payers might not reimburse for OAE tests when your provider uses them this way. UnitedHealthcare, for example, will not reimburse for OAE tests used as screens unless you can prove that the test "is medically necessary for the evaluation of hearing loss in ... infants and children age 3 years (up to, but not including, 4th birthday) or younger" or "children and adults who are or who are unable to cooperate with other methods of hearing testing (e.g. individuals with autism or stroke)" (Source: http://www.uhccommunityplan.com/content/dam/communityplan/healthcareprofessionals/reimbursementpolicies/Otoacoustical_Emissions_Testing_(R7104).pdf).