Pediatric Coding Alert

Question: Occasionally, our pediatrician has to stop a vision or hearing screening because the child doesn’t recognize letters or won’t stand or sit still for the duration of the screen. When this happens, should I append a modifier such as 52 or 53 to the 99173 or 92551 to indicate that the screening could not be completed?

North Carolina Subscriber

Answer: Appending modifier 52 (Reduced services) or 53 (Discontinued procedure) to 99173 (Screening test of visual acuity, quantitative, bilateral) or 92551 (Screening test, pure tone, air only) would be incorrect under these circumstances.

That’s because, per appendix A of the CPT^® manual, modifier 52 is used when “a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional.” In this case, the service was not really terminated by pediatrician choice; instead, the patient’s circumstances made completion of the service impossible.

Also, per appendix A, modifier 53 would not be correct as it is used to “terminate a surgical or diagnostic procedure.” Neither 99173 or 92551 fits those criteria.

Under these circumstances, your only real option would be to cancel and not bill for the service.