Pediatric Coding Alert

To optimize reimbursement for vision screening, pediatric practices need to understand when to use the new code and when an existing code should be billed.

Before the code was added in CPT Codes 2000 99173 (screening of visual acuity, quantitative, bilateral)pediatricians had no way to bill for vision screens done as part of preventive medicine services. But there is one problem with code 99173: It doesnt have a published RVU yet. That means there is no fee attached by Medicare or Medicaid. Insurance companies will be more likely to reimburse pediatricians for the new vision screening code the more doctors use it.

Screening in a pediatric office setting can be done easily by a primary-care pediatrician, says Harold P. Koller, MD, FAAP, FACS, chair of the American Academy of Pediatrics (AAP) section on ophthalmology and clinical professor of ophthalmology at Thomas Jefferson University in Philadelphia.

Early detection of vision problems is important. We believe that every child should be screened by the age of three, says Koller. The reason is amblyopia: If a child has vision problems, once the cells in the brain realize they dont need to process sight a certain way, they die off. Then, even if the eye problem is fixed, its too late. A clear, focused, single vision needs to be registered by the brain, he says. In addition to vision screening, the red reflex test and frank observance of eye alignment should be done at every well-baby check, adds Koller.

The fact that code 99173 lacks an RVU isnt unusual: The vaccine administration codes (90471 and 90472) are in the same position, but some commercial insurance payers are reimbursing for those codes. Nevertheless, it would make it much easier if there were an RVU. Were working hard to attach a value, he says. The section on ophthalmology at the AAP and the designated committees at the American Academy of Ophthalmology are working with the AMA RUC and HCFA to establish a defined and reimbursable fee. The only reason this code ever made it into CPT is that both societies fought hard for it.

When to Use 99173

Here are some basic vision testing methods that can be used, some of which are to be coded 99173, and some of which have separate codes.

1. Wall chart. This is typically a Snellen chart, although there are also wall charts that are pictures. The easiest way to use a wall chart with children, says Koller, who practices with Huntington County Eye Care Consultants in Meadowbrook, Pa., is to give the child cards, and [...]