Pediatric Coding Alert

Question: What codes are used at a pediatricians office for emergency visits? For vision screenings? Pure tone audiometry comprehensive exam?

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Answer: If a physician sees a patient immediately, pushing back all other scheduled patients, due to an emergency such as an asthmatic with severe breathing difficulties or a patient with a severe laceration, the pediatrician can bill 99058 (office services provided on an emergency basis) in addition to services rendered (for example, an evaluation and management [E/M] services code such as 99214). You should check with your payers reimbursement of this code, but it is not widely paid. Remember that in terms of compliance, you should be consistent and bill parents for a charge that you put on the claim form but was denied by the carrier. There are offices that write off charges denied by the insurance company. In the case of 99058, most insurance plans will pay if the diagnosis clearly demonstrates the urgent nature of the medical care.

Code 99173 (screening test of visual acuity, quantitative, bilateral) is the new 2000 code for vision screening tests. The test used must employ graduated visual acuity stimuli that allow a quantitative estimate of visual acuity (for example, a Snellen chart) and may be reported in addition to a well-visit. When 99173 is used as part of a general ophthalmological service or an E/M service of the eye, it is a diagnostic exam and not a screening test, and the code cannot be used. If a child comes in with an eye or a vision complaint, and you perform a vision test, that is no longer a screen, and you cannot bill 99173. Although the American Academy of Pediatrics (AAP) pushed hard for this code and hopes with its continued use will be widely accepted for reimbursement among carriers, it has no RVUs with which to establish a fee with.

There are two codes to consider for pure tone audiometry. Code 92552 is for pure tone audiometry (threshold); air only. Earphones are placed over the patients ears and he or she is asked to respond to tones of different pitches (frequencies) and intensities. The threshold, which is the lowest intensity of the tone that the patient can hear 50 percent of the time, is recorded for a number of frequencies on each ear.

Code 92553 is for pure tone audiometry (threshold); air and bone. Bone thresholds are obtained in a similar manner to 92552, except a bone oscillator is used on the mastoid or forehead to conduct the sound instead of tones through earphones. The air and bone thresholds are compared to differentiate between conductive, sensorineural or mixed losses. These codes are bilateral in nature. If an audiometry is performed on only one ear, attach modifier -51 (multiple procedures) to the appropriate code.

Answers to Reader Questions and You Be the Coder provided by Richard H. Tuck, MD, FAAP, member of the American Academy of Pediatrics (AAP) coding and reimbursement committee and a practicing pediatrician in Zanesville, Ohio; Thomas Kent, CMM, CPC, president of Kent Medical Management, a coding and practice management firm in Dunkirk, Md.; Victoria Jackson, chairwoman of the pediatric task force committee of the Medical Group Management Association (MGMA) and administrator/CEO of Southern Orange County Pediatric Associates, a pediatric practice in Lake Forest, Calif.; Mark S. Reuben, MD, FAAP, president of Reading Pediatrics, a private eight-pediatrician practice in Wyomissing, Pa.; and Nancy DeMarco LeMare, CPC, CCS-P, coding consultant for Central Maine Clinical Association, a multispecialty practice in Monmouth, Maine.