Pediatric Coding Alert

Question: When a certified medical assistant (CMA) performs a screening and cannot get a result due to the child moving too much or not cooperating, should I still code the procedure? The CMA ends up spending more time on these cases than completed ones. Is there a modifier I can use to indicate an attempted procedure?

Answer: You may report the screening codes provided the CMA fully documents the attempt and the reason she could not complete the tests, such as an uncooperative child. To indicate that the CMA attempted a thorough result but eventually gave up, attach modifier 53 (Discontinued procedure) to the test code.

For instance, if the CMA tried to test the child’s hearing but she refused to raise her hand or to indicate she heard a noise, append modifier 53 to 92551 (Screening test, pure tone, air only). For an incomplete attempt of a vision screen, attach modifier 53 to 99173 (Screening test of visual acuity, quantitative, bilateral).

Don’t miss: Check with the insurer for rescheduling time frames. Alabama Medicaid expects providers to rescreen uncooperative children within 30-45 days (http://medicaid.alabama.gov/documents/6.0_Providers/6.7_Manuals/6.7.4_Provider_Manuals_2008/6.7.4.3_July_2008/6.7.4.3_Jul08_A.pdf).  Rhode Island Medicaid recommends a rescreen within six months (www.dhs.ri.gov/Portals/0/Uploads/Documents/Public/Families with Children/epsdt_1pager.pdf).

You might have considered using modifier 52 (Reduced services) but this is not correct in this scenario. This modifier indicates the physician chooses not to perform part of a procedure.