Primary Care Coding Alert

Reviewed on May 22, 2015

The difference between pure tone hearing tests and threshold hearing tests can confound coders. When do you use 92551 (Screening test, pure tone, air only) versus 92552 (Pure tone audiometry [threshold]; air only)? Tip: Keep in mind that one is a screening test and one is a diagnostic test. 
 
Technical Details Point the Way

 
Knowing the technical differences and details of each hearing test will help coders choose the appropriate code.  The screening test is basically pass-fail, says Susan Beam, MA, CCC/A, an audiologist at Genesis Healthcare System in Zanesville, Ohio. During the test, a hearing screening device or audiometer produces a series of tones. The patient says whether he or she hears each tone. If the patient fails to hear one or more than one tone (depending on the office criteria for passing), he or she fails the test. At this point, the family physician (FP) will either schedule a threshold test or refer the patient to an audiologist to determine the exact problem. 
 
The threshold test is used to define the more specific diagnosis of the patient’s hearing problem, as opposed to the screening, which determines whether the patient has a hearing problem. Threshold testing identifies the softest level the patient can hear, Beam says. During the threshold test, the patient is presented with a series of tones at varying intensity (loudness). If the patient can hear the tone, the intensity is dropped in 10-decibel (dB) increments until he or she can no longer hear it. Next, the intensity is raised in 5-dB increments until the patient hears the tone again, then gradually dropped again, bracketing the threshold. 
 
The physician records results of the threshold test in an audiogram, a graph charting the levels the patient can hear. Coders can differentiate between the two tests by looking at the audiogram. The threshold will show a variation of different intensity levels recorded on the audiogram, Beam says. In contrast, results for the screening test will appear as just one level on the audiogram. Some physicians do not record screening results on the graph, but instead write in the chart screening.

Criteria for the Tests

 
Our doctor will conduct a hearing test on patients who have no signs and symptoms because he may want to fully examine a new patient, or he finds that an established patient has never had a hearing exam, says Pat Thompson, RHIT, coding analyst at Multicare HealthSystems in Tacoma, Wash. When the patient presents without a complaint, that test is a screening. 
 
Medicare does not cover hearing screenings, but some commercial payers do. Coders should report 92551 for the screening with ICD-9 V72.1x (Special investigations and examinations; examination of ears and hearing). Under ICD-10, choose the appropriate code from Z01.1- (Encounter for examination of ears and hearing). If the hearing screening is part of a routine physical, it can still be reported separately. For example, if a new patient has a preventive exam and the FP decides to conduct the hearing screening, code the appropriate preventive medicine code (99381-99387) and 92551. Link V70.0 (General medical examination; routine general medical examination at a health care facility) to the preventive medicine code and V72.1 to the 92551. Use V70.0 when performing the exam on adults. Use V20.2 (Routine infant or child health check) for screening tests on children Under ICD-10, choose a code from Z00.0- (Encounter for general adult medical examination) and Z00.12- (Encounter for routine child health examination).
 
Many practices code the definitive diagnosis for the hearing problem if the patient fails the hearing test. But despite the result of the test, the final diagnosis cannot be used with a screening exam. For example, an FP conducts a hearing screening on a 5-year-old new patient. The patient fails the test but has fluid in his ears causing conductive hearing loss. Report 92551 with V72.1. Use the diagnosis for the conductive hearing loss (e.g., 389.00 (Conductive hearing loss, unspecified) under ICD-9 or H90.2 (Conductive hearing loss, unspecified) under ICD-10 as the secondary code. 
 
Code 92552, on the other hand, is only for the diagnostic test. The patient has to present with signs and symptoms to use this code. If the patient fails a screening, the symptom is unspecified hearing loss, Beam says. Use 389.9 (Unspecified hearing loss) or choose a code from H91.9- (Unspecified hearing loss) for ICD-10. If the physician is able to make a definitive diagnosis following the threshold test, code with the final diagnosis as primary and the symptoms as secondary. For example, a patient who works in a loud factory complains of hearing loss. The FP administers a threshold test and determines that the patient has high-frequency hearing loss. Bill 92552 with 388.12 (Noise-induced hearing loss) as the primary diagnosis and 389.9 as the secondary diagnosis. Code 388.12 crosses to H83.3- (Noise effects on inner ear) in ICD-10.
 
Sometimes, the patient has been referred to his or her FP by an audiologist. Audiologists conduct group hearing screenings at schools or at work places that follow Occupational Safety and Health Administration (OSHA) rules. If a person fails the test during a group screening, the audiologist will send a report to the FP. The report informs the physician that the patient failed the test and that more extensive testing is needed. When the patient comes in for the threshold testing, report 92552 with the diagnosis for the signs and symptoms, unless a more definitive diagnosis is found. For example, a child is seen for an office visit with a note from the school that he failed two hearing screenings. The physician examines the patient’s ears, performs a threshold test and determines the child has otitis media. Report 92522 with the diagnosis code for otitis media (382.9, Unspecified otitis media). Code 382.9 crosses to H66.9- (Otitis media, unspecified) in ICD-10.
 
Although FPs usually test both ears, sometimes they will test only one when the patient reports hearing loss in just one. Because both 92551 and 92552 refer to testing both ears, coders need to append modifier -52 (Reduced services) to the hearing test code when only one ear is tested. Coding experts suggest reducing the fee when appending modifier -52. Also, practices should submit a KISS (keep it short and simple) letter when they use this modifier explaining why the services were reduced.