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Pediatric Coding Alert

Reader Questions:

Well Visit Doesn't Include Screens

Question: During a 4-year-old child's annual preventive medicine service, the pediatrician administers a vision screen using the Snellen chart and hearing screen by pure tone audiometry. Should I include the screens in the visit?

Connecticut Subscriber
Answer: No. You should separately code the vision (99173, Screening test of visual acuity, quantitative, bilateral) and hearing (92551, Screening test, pure tone, air only) screenings. 

The preventive medicine service codes (99382, Initial comprehensive preventive medicine evaluation and management of an individual; early childhood [age 1 through 4 years]; 99392, Periodic comprehensive preventive medicine reevaluation and management of an individual; early childhood [age 1 through 4 years]) do not include screening tests. CPT's preventive medicine service notes clearly state, "... screening tests, which are identified with their own CPT code, are separately reported."

You should code these annual well checks as:
  99382 or 99392 (depending on whether the child is a new or established patient) - preventive medicine service
  99173 - vision screen
  92551 - hearing screen. Link each procedure to V20.2 (Routine infant or child health check). The diagnosis describes a routine health check, as well as "routine vision and hearing testing," states ICD-9-CM 2005 Expert.

Payment: Some insurers and Medicaid programs, including Connecticut Medicaid, may bundle the vision screen with the preventive medicine service. You should, however, continue to code the visual acuity test and try to renegotiate with private payers for coverage.

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