Pediatric Coding Alert

Question: When a pediatrician spends time attempting a hearing and vision screen but cannot obtain the desired results, should she still bill the procedures? If so, what diagnosis codes should I use?


Indiana Subscriber

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

For instance, if the pediatrician 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).

You should still use the V code associated with the screen. Link 92551 to V72.1 (Special investigations and examinations; examination of ears and hearing) and 99173 to V72.0 (… examination of eyes and vision). The V codes indicate a reason for the encounter. Check with the insurer for rescheduling time frames. Alabama Medicaid expects providers to rescreen uncooperative children within 30-45 days. Indiana Medicaid recommends a rescreen within six months.

Answers to You Be the Coder and Reader Questions reviewed/provided by Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions in Tinton Falls, N.J.; Victoria S. Jackson, practice management consultant with JCM Inc. in California; and Richard H. Tuck, MD, FAAP, a pediatrician at PrimeCare of Southeastern Ohio.