Pediatric Coding Alert

Don't let frequent denials stop you from coding a vision acuity screening test (99173) with a preventive medicine service. Correct coding requires you to report the screening, but you may need some added ammunition to show insurers that they should cover the service.

Faced with numerous denials for CPT 99173 (Screening test of visual acuity, quantitative, bilateral), 99382-99383 and 99392-99393 (Preventive medicine services), many pediatric coders question if they should separately report a vision screening. "Am I misunderstanding the definition of 99173 when it is performed with a well-child exam?" asks Carmen Nino, office manager for pediatrician Takashi Yoshida, MD, in Sunnyvale, Calif. Payers keep denying 99173 as a nonpayable code stating that they consider it a component of the other billed E/M code.

Because the American Academy of Pediatrics (AAP) recommends that all preschool children be screened for visual acuity and strabismus by age 4 as a part of regular preventive care, most pediatricians perform 99173 with early (99382, 99392) or late childhood (99383, 99393) preventive medicine services. "Early detection and prompt treatment of ocular disorders in children is important to avoid lifelong permanent visual impairment," the AAP states.
1. Always Code the Visual Acuity Test
CPT permits billing a vision screening provided with a preventive medicine service, says Elizabeth B. Lange, MD, a pediatrician with Waterman Pediatrics in Providence, R.I. "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, Lange says.

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," Lange says.

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, I missed out on some private insurance money," she says.

Consistent reporting will give you concrete data to show insurers [...]