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Preventive Care

Daniel y Posted Fri 10th of May, 2013 14:50:22 PM

Is there Preventive Care CPT and ICD-9 for Opthamologist?

SuperCoder Answered Tue 14th of May, 2013 13:33:12 PM

CPT permits billing a vision screening provided with a preventive medicine service. “Other identifiable services unrelated to this screening test provided at the same time may be reported separately (e.g., preventive medicine services),” states CPT in the parenthetical notes following 99173. CPT’s introductory preventive medicine service notes reinforce, “Immunizations and ancillary studies including laboratory, radiology, other procedures or screening tests identified with a specific CPT code are reported separately.” Regardless of these directives, many managed-care organizations (MCOs) bundle the screening test with well-child healthcare.

Do not allow lack of coverage to deter you from reporting 99173. “Whether the insurer reimburses for this code or not, each practitioner should accurately code for all services provided to a patient on any given day,”.

Some Medicaid programs reinforce coding 99173 regardless of coverage. For instance, North Carolina Medicaid guidelines indicate that you should list vision screening CPT codes in addition to the preventive medicine CPT code. Despite this directive, the carrier allows no additional reimbursement for 99173.

Always billing the screening test will also ensure that you do not sacrifice any reimbursement. Rhode Island’s main two insurers, Blue Cross Blue Shield of Rhode Island (BCBSRI) and United Healthcare, kept denying 99173, so Lange’s billers stopped reporting the service. “Because some of the smaller companies, such as Cigna and Tufts, were paying for the code.

Consistent reporting will give you concrete data to show insurers that pediatrician-provided screenings cost less than ophthalmologist-performed services.

Before you blame noncoverage on the insurer, make sure you link the vision test to a different diagnosis than the preventive medicine service. CPT does not require separate diagnoses to reimburse a same-day E/M and other service. Using different ICD-9 codes, however, will help show the payer that the pediatrician performed two separate services.

Therefore, you should link V72.0 (Examination of eyes and vision) to 99173, and link V20.2 (Routine infant or child health check) to 99382-99383 and 99392-99393, says Cathy Fata, office manager for Riverdale Pediatrics P.C. in New York. “Do not use V20.2 for both the vision screening and the well exam.

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