Ophthalmology and Optometry Coding Alert

Ophthalmologists may be wondering if they should use a new code in CPT 2001 for vision screening. But this code is not for medical use by ophthalmologists or internists: Its for occupational medicine specialists in determining fitness for job duty. The code is 99172 (visual function screening, automated or semi-automated bilateral quantitative determination of visual acuity, ocular alignment, color vision by pseudoisochromatic plates, and field of vision [may include all or some screening of the determination[s] for contrast sensitivity, vision under glare]).

The description makes it clear that the code isnt for medical use, says Michael X. Repka, MD, the American Academy of Ophthalmologys representative to the AMA CPT Advisory Committee. This years version (99172) is a modification of last years (99173), says Repka, who practices at the Wilmer Eye Institute in Baltimore. This years CPT explicitly says its not for use in addition to an ophthalmological or E/M code. With last years code, which was created for pediatricians, an E/M code usually a preventive medicine services code can be used as well.

Code 99172 was requested by occupational medicine for in the screening of pilots and other professionals, adds Harold Koller, MD, FAAP, FACS, chairman of the American Academy of Pediatrics Section on Ophthalmology. Good vision is a job requirement for many of these professions, says Koller, who is also a professor of ophthalmology at Thomas Jefferson University in Philadelphia and attending surgeon at Wills Eye Hospital in Philadelphia. Code 99172 can be distinguished from 99173 (screening test of visual acuity, quantitative, bilateral ... Other identifiable services unrelated to this screening test provided at the same time may be reported separately ... When acuity is measured as part of a general ophthalmological service or of an E/M services of the eye, it is a diagnostic examination) by the ability to bill an E/M service in addition to 99173.

Code 99173 is another code not used by ophthalmologists or optometrists because it is a screening code and not a diagnostic service. Just because you see visual in a CPT descriptor doesnt mean the code is for ophthalmology.