Pediatric Coding Alert

Pediatricians and pediatric coders who incorrectly discriminate between in-office hearing tests open the door to an audit. Knowing the study related to these codes will alleviate the ring of fraud.

Practice management experts question the distinction between hearing tests CPT 92551 (Screening test, pure tone, air only) and 92552 (Pure tone audiometry [threshold]; air only), says Charles A. Scott, MD, FAAP, a pediatrician at Medford Pediatric and Adolescent Medicine in Medford, N.J. "Because the differences between 92551 and 92552 are miniscule, they wonder whether the patient's symptoms, the reason for the test, or the machine determines code selection." But you can put aside most of these concerns and focus on the tests.

You can further narrow your hunt by looking for the number of intensities the pediatrician records. "Code 92551 is a screening test," says Susan Beam, CCC/A, an audiologist with Genesis Health Care System at Bethesda Hospital in Zanesville, Ohio. The examiner typically places earphones on the patient and asks him or her to respond to tones at a single intensity (loudness) across several frequencies (pitches).

"The test determines if the patient needs further diagnostic testing," Beam says. If a patient fails to respond appropriately to the screening, additional testing is indicated.

When a pediatrician performs additional testing or more extensive testing, 92552 is appropriate. "Code 92552 is a threshold evaluation, which determines the lowest level of intensity (number of decibels [dB]) a certain frequency is heard," Scott says.

Similar to 92551, the pediatrician places earphones on the patient and asks him or her to respond to tones of different frequencies. But with 92552, the physician expands the testing to include multiple intensities. "The examiner presents tones at varying intensities until he reaches the threshold, the lowest level that the patient can hear 50 percent of the time," Beam says. The physician then records the threshold for a number of frequencies on each ear.

Pediatricians may record the results of 92551 and 92552 on an audiogram, a chart that shows the levels the patient can hear. Depending on the type of test performed, the results will differ. The threshold will show different intensity levels recorded, Beam says.

On the other hand, screening test results will appear as one level on the audiogram. Some physicians may not use a graph for screening results, but instead write "screening" in the chart.

If pictures don't reveal the correct code, documentation should illustrate the differences. Basically, if the pediatrician places the headphones on and checks to see if the child hears the tone in the normal range (anything below 20 dB for a given Hz [Hertz/frequency]) of hearing, you should report 92551, Scott says. If the physician goes as low as the patient can hear even within the normal range, he performs 92552. For example, the pediatrician sets his machine at 20 dB and varies the frequencies to see a response to all in both ears. Because the test does not involve multiple intensities, you should use 92551.

On the other hand, suppose the physician uses increasingly lower intensities to determine that at 4,000 Hz, the lowest limit of hearing is 15 dB, and at 3,000 Hz it is 5 dB, but only 10 dB at 2,000 Hz, etc. Documentation reflects various intensities, which makes 92552 appropriate.