Primary Care Coding Alert

Question: We tried to do an audiogram with a 7-year-old patient, but we were unable to obtain it. Isn't there a code for that?

Pennsylvania Subscriber

Answer: CPT doesn't contain a specific code for unobtainable audiogram. You-ll instead have to use a modifier to explain the extenuating circumstances. One or two modifiers may be applicable, depending on why the physician didn't obtain the audiogram.

Option 1: If the FP obtained an audiogram on one ear but not the other, append the audiogram code (92551, Screening test, pure tone, air only) with modifier 52 (Reduced services). Code 92551 is bilateral, unlike 69210 (Removal impacted cerumen [separate procedure], one or both ears), which may be unilateral or bilateral.

For objective vision/hearing testing not completed, use modifier 52 plus the CPT code for standard testing method, according to Pennsylvania Children's Checkup (EPSDT) Program Periodicity Schedule and Coding Matrix. This is consistent with CPT, which indicates that codes 92551-92597 are bilateral, and you should append modifier 52 to the procedure code if the FP performs the treatment to one ear instead of two.

Option 2: If the FP terminated the diagnostic procedure because the equipment was faulty or the patient refused to cooperate, append modifier 53 (Discontinued procedure) to the audiogram code, such as 92551-53.