Pediatric Coding Alert

Question: A new patient came to our office for a hearing screening because she failed it at her well check visit. The screening results were normal. The insurance company sent a denial stating they need more than a single V code on the claim. How do you suggest we handle this?

Vermont Subscriber

Answer: The correct diagnosis for your case is V72.11 (Encounter for hearing examination following failed hearing screening). If you report V72.11 and receive a denial, the reason might lie with your payer instead of your coding. V72.11 is a fairly recent addition to ICD-9, so the payer might be slow in updating their system or coding parameters. Appeal the case and include documentation of when you should submit V72.11.