Pediatric Coding Alert

Question: Parents often bring their child in for a physical and want their childs hearing tested. With a hearing exam, the physical exam takes twice as long. How should we code these situations to get additional reimbursement for time spent on the hearing exam?

Tennessee Subscriber

Answer: Many insurance companies believe that audio screening is an integral part of a well visit and dont realize how time-consuming it is. Some plans require a separate billing for audio screens, but this usually presents a problem. If you perform the audio screen as part of the well visit, it will be denied by the payer.

The best solution is not to conduct the audio screen as part of the well visit and schedule another visit for the screening. Most children with hearing problems are referred by the school nurse. You would code the subsequent hearing screen with an office visit code, such as 99212 and 92551 (screening test using pure tone, air only). Calibrated electronic equipment is used, and both ears are tested. (See the November 2000 Pediatric Coding Alert, Gain Proper Payment for Hearing Screening and Testing, on page 85.)