​Coding Fact Sheet for Primary Care Pediatricians

While coding for hearing screening is relatively straightforward, ensuring that appropriate payment is received for such services is a more complicated matter. This Coding Fact Sheet will provide you with a guide to coding for pediatric hearing screening. While we have provided you with some suggested codes, it should be noted that payer recognition of codes might vary. Most plans are now required to cover hearing screen services under the Affordable Care Act, however, that may still vary.

Diagnosis Codes

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Codes (Prior to October 1, 2015)

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Codes (On or after October 1, 2015)​

Commonly Reported Diagnosis Codes Related To Primary Care Pediatricians & Hearing Loss

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Other Diagnosis Codes Related To Hearing Loss

Nervous System and Sense Organs

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Congenital Anomalies

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Injury and Poisoning

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Symptoms, Signs, and Ill-Defined Conditions

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Other

NOTE: The ICD-9-CM codes below are used to deal with occasions when circumstances other than a disease or injury are recorded as "diagnoses" or "problems." Some carriers may request supporting documentation for the reporting of V codes.

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Procedure Codes

Current Procedural Terminology (CPT®) Codes

Commonly Reported Procedure Codes Related To Primary Care Pediatricians & Hearing Loss

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Health and Behavior Assessment/Intervention Codes

These codes cannot be reported by a physician.

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The focus of the assessment is not on mental health but on the biopsychosocial factors important to physical health problems and treatments.

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The focus of the intervention is to improve the patient's health and well-being utilizing cognitive, behavioral, social, and/or psychophysiological procedures designed to ameliorate the specific hearing-related problems.

Healthcare Common Procedural Coding System (HCPCS) Level II Procedure and Supply Codes

CPT codes are also known as Healthcare Common Procedure Coding System (HCPCS) Level I codes. The Healthcare Common Procedure Coding System also contains Level II codes. These Level II codes (commonly referred to as HCPCS "hick-picks" codes) are national codes that are included as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) standard procedural transaction coding set along with CPT codes.

HCPCS Level II codes were developed to fill in the gaps in the CPT nomenclature. While they are reported in the same way as a CPT code, they consist of one alphabetic character (A-V) followed by four digits. In the past, insurance carriers did not uniformly recognize HCPCS Level II codes. However, with the advent of HIPAA, carrier software systems must now be able to recognize all HCPCS Level I (CPT®) and Level II codes.

HCPCS Hearing Services Codes

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Vignettes

Modifiers

25  Significant and separately identifiable evaluation and management service

50  Bilateral procedure

52  Reduced procedural service (can be used when a code indicates a bilateral hearing screen/test, but only one ear is tested)

59  Distinct procedural service

Last Updated

08/12/2021

Source

American Academy of Pediatrics