Pediatric Coding Alert

You've now got clear backing that screenings are separately reportable.

You no longer have to think of physicians providing vaccines as give-away services.

Tired of fighting for vision screen (99173, Screening test of visual acuity, quantitative, bilateral) coverage on a preventive medicine service claim (such as 99392, Periodic comprehensive preventive medicine reevaluation and management ... early childhood [age 1 through 4 years])? "We'll now have notes to copy and submit from CPT that clearly state the well check does not include the screening," notes Deanna Wolfaram, physician coding educator for Bebit Clinic in Beloit, Wis.

Benefit: Having specific black and white language in CPT 2009 will be very helpful in pursuing payment from insurers, says Richard Tuck, MD, FAAP, a former member of CPT's relative value scale update committee and a pediatrician with PrimeCare of Southeastern Ohio in Zanesville.

Revised guidelines include examples of types of screening tests that should be reported separately from preventive medicine service codes. Although many practices struggle the most with obtaining vision screening payment, you can use this additional support to challenge other preventive medicine-related services, including:

• hearing screening (92551, Screening test, pure tone, air only)

• developmental testing (96110, Developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report)

• vaccine products (90476-90749)

• immunization administrations (90465-90474).

Time-saver: Create an appeals package that you can send to insurer representatives to explain that CPT considers these items separately reportable. Include a copy of CPT's revised "Preventive Medicine Services" guide-lines that state,"Vaccine/toxoid products, immunization administrations, ancillary studies involving laboratory, radiology, other procedures, or screening tests (e.g., vision, hearing, developmental) identified with a specific CPT code are reported separately" (CPT 2009 Professional Edition, page 29).

Don't miss: For payers that bundle immunizations with preventive medicine services, highlight 99381-99395's revised definitions. The preventive medicine service codes (99381-99397) were revised to exclude the reference to ordering of "appropriate immunization(s)," as these are reported separately, according to the revised Preventive Medicine Services guidelines.