Pediatric Coding Alert

Question: A child came in for a hearing exam in which the pediatrician found normal test results. My colleagues think we should use diagnosis code V72.1, but I disagree because the patient came to us after failing a school hearing exam. Should we code a symptom, such as hearing loss, with the worried-well V code, or should we use abnormal auditory function study (794.15)? Which ICD-9 code do you recommend?


Arizona Subscriber


Answer: You're right that you should reserve V72.1 (Special investigations and examinations; examination of ears and hearing) for a routine hearing screening, such as 92551 (Screening test, pure tone, air only). But V72.1 is normally associated with the routine hearing screening that occurs at a preventive medicine service, such as 99392 (Periodic comprehensive preventive medicine re-evaluation and management of an individual ...; early childhood [age 1 through 4 years]).

The patient in your example, however, is not presenting for a routine screening. She is instead coming in due to a problem with the initial test. Therefore, for the retest, you have two ICD-9 options:

1. If the pediatrician diagnoses a problem at the retest, you should report the definitive diagnosis.

2. When the retest is inconclusive, or as in your case is normal, you should instead use the ICD9 code for the signs or symptoms that prompted the retest.

Best bet: In your case, you should assign 388.40 (Abnormal auditory perception, unspecified). Without a definitive hearing-loss diagnosis, you should report the symptom - hearing-loss complaint - that prompted the visit. Do not report 794.15 (Abnormal auditory function studies). A function study is different from an audiometric examination.

For the hearing test that the pediatrician performed at this second encounter, assign 92552 (Pure tone audiometry [threshold]; air only). Because the patient failed the initial hearing screening, the pediatrician would perform the more extensive threshold test to identify hearing-loss specifics.

If the pediatrician also performs a significant, separate E/M service from the testing, you should also report the appropriate-level office visit code, such as 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient). Some insurers may require you to append the E/M code with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).