Pediatric Coding Alert

 Tip: 388.40 can often do the trick

Looking for the key to collecting fair hearing-test reimbursement? Look no further than the diagnosis side of your claim form.

Because pediatricians rarely own sound-proofed rooms and expensive testing equipment that otolaryngologists and audiology centers have, many payers are reluctant to pay a pediatric practice for hearing tests, says Victoria Jackson, CEO of the Orange County Pediatric Association in El Toro, Calif. "If you're doing a regular hearing screening as a part of an exam and physical, most insurance companies will just bundle it with the physical," even though CPT clarifies that screenings shouldn't be considered a part of preventive medicine services.

But you can collect for hearing tests - you simply need to know how to use the proper diagnosis codes to get what you deserve.

72.1 Is Greater Than 20.2

"The V20.2 gets denied on a regular basis," says Wendy Howlett-Holley, CPC, with Pediatrics Associates in Norfolk, Va. The descriptor for V20.2 (Routine infant or child health check) includes the line "Routine vision and hearing testing," so coders think it's the only diagnosis that they can use.

If your payer likes to bundle the hearing screen into the exam, you can use V72.1 (Special investigations and examinations; examination of ears and hearing), Howlett-Holley says. The term "special investigations" makes some coders wary of using V72.1 for routine hearing screenings, but a closer examination of the descriptor shows that the code includes "routine examination of specific system."

So, say a physician performs a routine annual exam and a hearing screening on a 4-year-old established patient. You would report 99392 (Periodic comprehensive preventive medicine re-evaluation and management of an individual including an age- and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization[s], laboratory/diagnostic procedures, established patient; early childhood [age 1 through 4 years]) and link it to V20.2. For the hearing screening, you would likely report 92551 (Screening test, pure tone, air only) linked to V72.1.

V Codes May Not Guarantee Payment

Even though it's more specific than V20.2, V72.1 can still be a "a pretty benign code" - as are all V codes - and many payers won't pay for it, Jackson says. But before you give in, check whether any of the codes from the 380-389 series (Diseases of the Ear) fit your claim.

"You usually do a hearing test for a specific condition," says Michelle Logsdon, CPC, CCS-P, a coding and reimbursement specialist in Toms River, N.J. Coding for a specific condition is much more likely to yield better results.

Often a parent will ask the doctor to check a child's hearing because the child has had a history of otitis or perforated eardrums, Jackson says. Even a history of chronic ear infections can cause parents to wonder. All of those conditions - and countless others - could qualify as acceptable ICD-9 codes to link to a hearing test.

In most instances, the pediatrician shouldn't use one of the hearing loss codes (389.x) because the tests that pediatricians perform in their offices usually aren't sophisticated enough to definitively establish hearing loss.
Suppose a patient comes in because she failed to hear below 25 decibels on a hearing screening administered at school. You still don't have enough information to conclude that the child has hearing loss, and a hearing screening (92551) or test such as 92552 (Pure tone audiometry [threshold]; air only) may not be enough to confirm a 389.x diagnosis. In that case, you should use 388.40 (Abnormal auditory perception, unspecified).