Pediatric Coding Alert

Question: The insurance company is denying 92587 with Z01.10 for insufficient diagnosis. What are we doing wrong?

Codify Subscriber

Answer: Insurance may be denying 92587 (Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report) with Z01.10 (Encounter for examination of ears and hearing without abnormal findings) for one of two related reasons.

Because the tests measure the quiet sounds produced when the hair cells in the inner ear vibrate, the patient does not have to indicate whether or not they perceive a sound. This makes otoacoustic emissions tests (OAEs) ideally suited to younger patients who are unable to verbally or visually communicate their ability to hear frequencies. However, OAEs are not as effective as hearing screens as other tests such as 92551 (Screening test, pure tone, air only) or 92552 (Pure tone audiometry (threshold); air only).

This means that many payers will not reimburse for OAEs when used as screens for older patients and may have a related policy that will allow for reimbursement for 92587 only when used as a screen for patients of a certain age. See, for example, UnitedHealthcare’s policy on reimbursing for OAEs when used as screens for patients up to the age of 4, which can be found at:   www.uhccommunityplan.com/content/dam/uhccp/healthcareprofessionals/reimbursementpolicies/Otoacoustical_Emissions_Testing_(R7104).pdf).