Bernadette Posted Tue 18th of February, 2014 14:20:20 PM
We need clarification on which ICD-9-CM to use for the vision screening, CPT code
99173, during a well visit,
V72.0. We have read that the appropriate ICD-9-cm code for reporting vision screenings is
V20.2 when performed as part of the preventive medicine service. ICD-9-CM code
v72.0 would be reported when a screen was reported for another reason. So,
V72.0 could not be reported if we perform the
99173 during a well/preventive medicine visit? Is this correct?
SuperCoder Answered Wed 19th of February, 2014 08:16:01 AM
Basics of 99173: CPT permits billing a vision screening provided with a preventive medicine service. Regardless of that, many managed-care organizations (MCOs) bundle the screening test with well-child healthcare.
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.
However, 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. In addition, depending on your insurer, you may need to append modifier 25 (Significant, separately identifiable E/M service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the appropriate preventive medicine service code.
Keep in mind: As a general rule, if a plan indicates a service, in this case vision screening, is included in the preventive medicine service, your battle is with the insurance company and you can’t balance bill the patient. If, on the other hand, they indicate it’s a non-covered service, you can balance bill the patient (an ABN is optimal).
Bernadette Posted Tue 05th of August, 2014 12:22:17 PM
I have an additional question regarding older patients who come in for the routine visit and the routine eye exam. Could we bill
99173 even though the patient is 19 years old and we bill
V70.0 with the appropriate preventive E/M
V72.0 be appropriate to use?
SuperCoder Answered Wed 06th of August, 2014 14:50:59 PM
Thank you for your question. Please see the responses below, however the above criteria is still to be adhered to for guidelines.
I have an additional question regarding older patients who come in for the routine visit and the routine eye exam. Could we bill V20.2 with 99173 even though the patient is 19 years old.....
YES. These codes are ok to bill. Many Family Medicine practices and Pediatric offices see patients beyond the "adult" age of 18. There is not an age restriction on the codes, except for over 28 days for a health check.
and we bill V70.0 with the appropriate preventive E/M 99395?
YES. This is also correct coding for routine preventive visit with supporting documentation of a preventive exam. Please be advised of the above response that a vision exam is typically bundled into a preventive visit (annual exam, physical, etc)
Would V72.0 be appropriate to use?
This would be used when the patient does not have any other complaints and is in otherwise good health. The patient presents for routine, preventive care of the eyes.