Pediatric Coding Alert

Question: We tried to do an audiogram with a patient, but we were unable to obtain it. Isn't there a code for that?

Pennsylvania Subscriber

Answer: CPT doesn't contain a specific unobtainable audiogram code. You'll instead have to use a modifier to explain the extenuating circumstances. One or two modifiers may be applicable, depending on why the physician didn't obtain the audiogram.

Option 1: If the pediatrician obtained an audiogram on one ear but not the other, append the audiogram code (92551, Screening test, pure tone, air only) with modifier 52 (Reduced services). Code 92551 is bilateral, unlike 69210 (Removal of impacted cerumen, one or both ears), which is unilateral and bilateral.

For objective vision/hearing testing not completed, use modifier 52 plus the CPT code for standard testing method, according to Pennsylvania Children's Checkup (EPSDT) Program Periodicity Schedule and Coding Matrix.

Option 2: If the pediatrician terminated the diagnostic procedure because the equipment was faulty or the patient refused to cooperate, append modifier 53 (Discontinued procedure) to the audiogram code, such as 92551-53.