Pediatric Audiology Billing Guidelines for 2023

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Pediatric Audiology Billing Guidelines
for 2023
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Pediatric Audiology Billing Guidelines for 2023
Basics of Pediatric Audiology Billing
Guidelines Pediatric audiology billing guidelines
can be confusing as it varies from one insurance
carrier to another. The following pediatric
audiology billing guidelines includes commonly
used diagnosis/procedure codes, and their billing
scenarios. Procedure code guidance is based on
the American Medical Associations Current
Procedural Terminology (CPT) coding definitions.
The pediatric audiology billing guidelines shared
in this article mostly applies to Medicare.
Medicaid and other commercial insurance carriers
might include, omit, or further define codes for
billing the benefits they allow. Always check
your patients health plan coverage and payer
specific guidelines to avoid claim
denials. Pediatric Audiology Billing Guidelines
for 2023 Diagnosis Code for Newborn Hearing
Re-screening The diagnosis code (ICD-10-CM) for
newborn hearing re-screening is Z01.110
(Encounter for hearing examination following
failed hearing screening). As per ICD-10 CM, this
diagnosis code is included under Encounter for
Hearing Examination Following Failed Hearing
Screening as a primary diagnosis code for
newborn hearing follow-up testing. Some state
programs and commercial insurance carriers might
require an ICD-10-CM diagnosis code such as
Unspecified Hearing Loss, even when test
results are normal. So you need to confirm with
your payer regarding diagnosis coding
requirements for newborn hearing re-screening.
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Pediatric Audiology Billing Guidelines for 2023
Visual Audiometry and Conditioning Play
Audiometry Procedure codes 92579 (i.e., Visual
Audiometry) (VRA) and 92582 (i.e., Conditioning
Play Audiometry) (CPA) describe specific,
independent pediatric test procedures. These two
codes are differentiated by the method of
response reinforcement used and the types of
stimuli that are considered part of the
procedure. These codes currently do not have
detailed code descriptions. Description of VRA
test procedures included both speech and tonal
stimuli as part of the test protocol. In
contrast, CPA test protocols included tonal
stimuli but did not include speech stimuli. If
CPA testing is completed and speech measures are
performed as part of the evaluation, then a code
that best describes the speech measure, such as
speech threshold audiometry (92555), select
picture audiometry (92583), or speech audiometry
threshold with speech recognition (92556), can
also be reported. Generally, these codes should
not be used in addition to pure tone audiometry,
air only (92552) or air and bone donduction
audiometry (92553) to indicate a method of
testing. Limited or No Audiologic Test
Results Its challenging to bill limited or no
audiologic test results as the codes that you
select should accurately reflect the procedures,
techniques, and effort that were used, not
specifically the number of responses that were
obtained. In spite of frequent reconditioning or
test reinstruction, you might obtain limited
audiologic information. In such cases the
audiologist has used considerable effort, various
procedures, and/or different reinforcement
techniques to obtain those limited results. So,
these services would not be considered a reduced
service.
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Pediatric Audiology Billing Guidelines for 2023

• To receive accurate reimbursements, documentation
  of the test session should include the efforts
  made to obtain test results. You can document a
  time notation in the patients medical record as
  an estimate of the time and effort involved when
  limited audiologic information is obtained. There
  may be a number of reasons why no audiologic
  results are obtained. However, in a situation
  where a child is completely uncooperative with
  any test procedure, the audiologist has a choice
  of cancelling the appointment altogether or using
  a reduced service modifier (-52) to indicate that
  the entire protocol associated with the
  diagnostic procedure was not completed.
• Middle Ear Function Test
• Four procedure codes are available to report
  middle ear function tests that were frequently
  performed together on the same date of service.
• CPT code 92567 Tympanometry (impedance testing)
• CPT code 92568 Acoustic reflex testing,
  threshold
• CPT code 92550 Tympanometry and reflex threshold
  measurements
• CPT code 92570 Acoustic immittance testing,
  includes tympanometry (impedance testing),
  acoustic reflex threshold testing, and acoustic
  reflex decay testing
• If acoustic reflex threshold testing or acoustic
  reflex threshold testing and acoustic reflex
  decay testing are performed on the same date of
  service as tympanometry, you must report the
  bundled code that describes what has been
  performed.

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Pediatric Audiology Billing Guidelines for 2023
You may not report tympanometry (92567) and
acoustic reflex threshold testing (92568)
separately on the same date of service. The
tympanometry-only procedure code (92567) should
be used if wideband reflectance or
multi-frequency tympanometry tests are completed.
The code is a session-based code, meaning that
92567 can only be billed one time per day, even
if standard and multi-frequency tympanometry as
well as wideband reflectance testing are all
completed on the same day. An extended service
modifier (-22) could be considered when
multi-frequency tympanometry and wideband
reflectance testing are completed on the same
day. Otoacoustic Emissions (OAE) Testing The CPT
codes 92558, 92587, and 92588 are used to clearly
describe the differences between screening OAE
and limited versus comprehensive OAE evaluation.
The OAE codes assume that testing is completed in
both ears. You have to use modifier -52 (reduced
service) to the CPT code for unilateral
testing. Auditory Brainstem Response (ABR)
Testing The CPT codes 92650, 92651, 92652 and
92653 are used to report auditory brainstem
response (ABR) screening and testing. The
auditory evoked potential (AEP) testing codes
assume that testing is completed in both ears. As
mentioned earlier, you have to use modifier -52
(reduced service) to the CPT code for unilateral
testing.
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Pediatric Audiology Billing Guidelines for 2023
If you perform threshold-search ABR and auditory
steady-state response (ASSR) testing on the same
day, you have to use procedure code 92652, which
is the most appropriate code for billing ASSR at
this time. ASSR is considered to be a type of
auditory evoked potential (AEP) test and
currently does not have a specific CPT code. An
extended service modifier (-22) could be
considered when both ABR and ASSR are completed
on the same day, but only if the time and work to
perform AEP testing is substantially greater than
usual. Auditory Processing Evaluation and Aural
Rehabilitation Status CPT codes 92620 and 92621
represent auditory processing evaluation while
CPT codes 92626 and 92627 represent evaluation of
aural rehabilitation status. For example, first
bill CPT code 92620 (i.e., evaluation of central
auditory function, with report initial 60
minutes), then report CPT 92621 for each
additional 15 minutes of evaluation time. CPT
codes 92626 and 92627 reflect the evaluation of a
childs ability to use residual hearing with an
auditory implant, such as a cochlear implant.
92626 and 92627 cannot be used as counseling
codes or services unrelated to pre- or
post-implant auditory function evaluation. Legion
Healthcare Solutions is a leading medical
billing company providing complete billing and
coding services. We shared pediatric audiology
billing guidelines for physician education
purpose, for detailed understanding you can refer
the ASHA (American Speech-Language-Hearing
Association) article. In case of any assistance
required for medical billing and coding services,
contact us at 727-475-1834 or email us at
info_at_legionhealthcaresolutions.com
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