Pediatric Coding Alert

Question: When my registered nurse (RN) attempts to do an audio or vision screen, but the child cannot be conditioned or is non-cooperative - and my RN spends more time on this than with a child who breezes through the screen - can I charge for the procedure?

New York Subscriber

Answer: It's probably safe to report the screen, if the RN documents the attempt and conditioning problem or the child's non-cooperation.
 
You should append modifier -53 (Discontinued procedure) to the screen (such as CPT 99173 , Screening test of visual acuity, quantitative, bilateral; and 92551, Screening test, pure tone, air only).
 
"Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well-being of the patient, it may be necessary to indicate that a surgical procedure was started but discontinued," states Appendix A - Modifiers. Because the nurse, in your case, started but discontinued the screen, modifier -53 appropriately describes the diagnostic procedure.
 
Don't make this mistake: Use modifier -52 (Reduced services) on 99173 or 92551. Modifier -52 identifies a service that the physician chooses to reduce or eliminate.
 
For instance, if a pediatrician ordered a threshold exam on a child's right ear only, you would append modifier -52 to 92552 (Pure tone audiometry [threshold]; air only). CPT considers 92551-92552 bilateral codes. So if a nurse conducts the test on one ear only, you use modifier -52, according to CPT's introductory audiologic function test notes.