Bill Vision Screen With Preventive Medicine Codes
Code 99173 may be billed along with the preventive medicine codes (99381-99385 and 99391-99395) to ensure adequate reimbursement for vision screenings. For example, a 3-year-old established patient comes in for a checkup (99392, periodic preventive medicine re-evaluation and management of an individual including a comprehensive history, comprehensive examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate laboratory/diagnostic procedures, established patient; early childhood [age 1 through 4 years]). If the pediatrician performs a vision screening during the check-up, he or she may bill 99173 in addition to 99392. You do not need to use modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) when you bill 99173 with a preventive medicine service because the code descriptor for 99173 specifically refers to its use along with preventive medicine services.
Although the pediatrician is most likely to perform the screening during a well visit, there are other circumstances under which you might use 99173 alone. If, for instance, the patient is attending a summer camp that requires vision screens for every child and the sole reason for the office visit is the screen you would code only 99173.
Use 99173 Only for Screenings
Physicians should not use 99173 if a patient complaint led to the visual acuity testing. If there is a complaint, the test is no longer a screening exam, but a diagnostic test.
If, for example, the school asks a parent to have the childs vision tested because the child is having trouble seeing the blackboard, you should not use 99173; instead, use the appropriate-level evaluation and management (E/M) services code (99201-99205 or 99211-99215). In another example, if a child falls and hurts his or her eye, and complains of blurry vision, any visual acuity test would be a diagnostic test rather than a screening, and 99173 would not be proper coding. Even though you may administer the same test as for a screening, you cannot bill 99173 if the test is performed pursuant to a complaint.
Sure-Sight Vision Screener Not Used for Screens
The code descriptor for 99173 specifies quantitative estimate of visual acuity. Although this means that use of a simple paper wall chart will not justify use of 99173, Dont let this make you think you need to use a complicated or expensive machine, says Harold Koller, MD, FAAP, FACS, chairman of the AAP section on ophthalmology, professor of ophthalmology at Thomas Jefferson University and attending surgeon at Wills Eye Hospital in Philadelphia. A projection chart is semi-automated, he explains, as is the Snellen projector chart.
For color screening you can use a book obtained from an optical supply shop that has pictures in it, Koller says. The pictures are created specifically for use with children.
The new Welch-Allyn Sure Sight Vision Screener is not a true vision screener, Koller warns. Its a refractor, he says. It is not needed for screening. Refraction tests (92015, determination of refractive state) are performed by ophthalmologists and optometrists prior to prescribing eyewear, and should not be confused with the vision screenings performed by a pediatrician.
Gaining Payer Recognition
Insurance companies generally take time to recognize new codes. This has been particularly true of 99173; many payers claim that the vision screen is included in a well visit. Although this used to be so, it is no longer the case.
Vision screening is considered an important part of good pediatric care, and pediatricians should bill for the service when it is provided. And they must pursue denials as well, stresses Richard H. Tuck, MD, FAAP, member and founding chairman of the AAP committee on coding and reimbursement. Tuck recommends that you send the payers provider representative a copy of the descriptor and CPT guidelines for 99173, highlighting the portion of the descriptor that specifies Other identifiable services unrelated to this screening test provided at the same time may be reported separately (e.g., preventive medicine services)."