Ophthalmology and Optometry Coding Alert

You may find better amblyopia testing results -- and more steady payment -- with visual evoked potential testsOphthalmologists who test nonverbal patients for vision impairments are increasingly turning to visual evoked potential (VEP) testing for its diagnostic advantages over other vision screening tests. VEP can also be more lucrative than other tests, with some insurers reimbursing as much as $160.Although payment for vision screening (99173, Screening test of visual acuity, quantitative, bilateral) can prove hard to come by, reimbursement is much more straightforward for VEP test code 95930 (Visual evoked potential [VEP] testing central nervous system, checkerboard or flash). Instead of the SureSight Vision Screener (99173), "I use the VEP machine (95930)," says Richard Lander, MD, FAAP, a physician in Livingston, N.J. "It is a good screening test for amblyopia that is able to test kids as young as 6 months old."Test Nonverbal Children With Staff-Run TestThe American Academy of Pediatrics Bright Futures evidence-based age-specific guidelines recommend that children have an early childhood vision screen at age 3 or 4 years. And the U.S. Preventive Task Force, an independent panel of experts in primary care and prevention that reviews the evidence of effectiveness and develops recommendations for clinical preventive services, recommends screening to detect amblyopia, strabismus and visual acuity defects in children younger than 5 years of age.Benefit: A VEP machine, such as the Enfant Pediatric Vision Testing System manufactured by Diopsys, lets you detect visual deficits, such as optic nerve disorders, asymmetric refractive errors, and other problems that could lead to amblyopia in children who can't tell you they have visual problems.The child may be preverbal or unreliably tested with subjective vision tests, says Diane C. Fulton, director of insurance/medical coding and billing for Diopsys Inc. in Pine Brook, N.J. Or with older children, the patient may not recognize that he has a problem because his sight seems "normal" to him.Supervision: Medicare's Physician Fee Schedule assigns the technical component of VEP testing (95930-TC) supervision indicator "21," notes Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley and Associates in Clearwater, Fla. This supervision level allows certified technicians to perform the test under the general supervision of a physician. However, uncertified technicians must perform the test under direct supervision. "This means that the technician must be certified to perform the test when a physician is not present in the office suite," Mac explains. Only a physician can perform the interpretation of the test (95930-26).Look for many non-Medicare payers to follow these same guidelines. "In the absence of specific policies for diagnostic tests, most payers, including Medicaid, other federal programs and private payers, will follow the policies developed by CMS," Mac says.Expect Payment Most of the TimeCPT assigns 95930 [...]