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Family Practice Coding Alert

Get Paid for Back-to-School Hearing and Vision Screening

For many students in the fall, "back to school" also means back to the doctor's office. Virtually all public and private institutions require periodic vision and hearing tests to evaluate whether the student's physical development is progressing along a normal timeline. In most instances, these assessments are reported in addition to other services provided during the same visit. However, professional coders must be alert to a number of important factors -- whether the service is diagnostic instead of screening, for instance, determines which code is reported.
Vision Screening Code Is Often Overlooked  
FPs were delighted in 2000 when a new CPT code was added to describe basic vision screening, often referred to as Snellen or wall chart tests. "Before 99173 (screening test of visual acuity, quantitative, bilateral) was implemented, practices had no specific code to report these services," says Imee Tanseco, CPC, coding supervisor for Argus Medical Management LLC, a Long Beach, Calif., firm that provides coding and billing services for primary care and pediatric practices.
She notes that many practices have yet to adopt this code or use it consistently. "I find that many family physicians continue to use the unlisted-procedure code to describe vision screening (99199, unlisted special service, procedure or report). They're not used to having a specific code and are still reporting it incorrectly," she says.
Another common error, Tanseco says, occurs when family practice coders assume vision screening is bundled into E/M services performed the same day. "This isn't the case, and CPT is very clear on this issue in notes following the code description. 99173 should be reported in addition to the office or preventive-care visit."
For instance, if a girl entering kindergarten is seen for her annual checkup and the physician checks her eyesight, coders should report either 99383 (initial preventive medicine; late childhood [age 5 through 11 years]; new patient) or 99393 (periodic preventive medicine; late childhood [age 5 through 11 years]; established patient) along with 99173. Modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) is not appended to the E/M code because no edits govern these codes.
Coders should recognize that 99173 is clearly defined only as a screening exam. When acuity is measured during a general ophthalmologic service or an E/M service of the eye, this service is then a diagnostic examination and not a screening test.  In these cases, testing visual acuity is considered part of the general ophthalmological or E/M service and is not separately reported using 99173.
Vision Screening Has No Published RVUs