Pediatric Coding Alert

Question: According to CCI, codes for pure tone audiometry (CPT 92552 ) are bundled with office visit codes. Can we still code these separately when administering a checkup? If not, can we use 92551 instead?

Missouri Subscriber

Answer: Many payers assume that pediatricians do not have the equipment necessary to bill 92552 (pure tone audiometry [threshold]; air only), and therefore will not reimburse for the procedure. Also, because 92552 is a diagnostic procedure and not a screening, it would raise a red flag when coded with a well visit. Assuming 92552 is the correct code, the insurance company may be denying reimbursement because you are billing with a preventive medicine service. You should bill 92552 with an office visit (99201-99205 or 99211-99215) because the test is performed pursuant to a complaint or symptom, such as a hearing problem. A hearing screen, on the other hand, would be coded 92551 (screening test, pure tone, air only) and is the proper code for a screening performed as part of a well visit.


Reader Questions and You Be the Coder were answered by Richard H. Tuck, MD, FAAP, a member of the American Academy of Pediatrics coding and reimbursement committee, and a practicing pediatrician in Zanesville, Ohio; Susan Callaway, CPC, CCS-P, an independent coding auditor in North Augusta, S.C.; and Charles J. Schulte III, MD, FAAP, chair, AAP coding and reimbursement committee, CPT advisor representing AAP, and a practicing pediatrician in Washington, D.C.