Pediatric Coding Alert

If you're considering replacing technically difficult and time consuming Snellen eye chart testing with new technology equipment, weigh these pros and cons.

Frustrated by vision screening for 3- and 4-year-olds using traditional eye charts? You're not alone. "Barriers to office screening reported by pediatricians include lack of cooperation by children (49 percent), screening being too time-consuming (23 percent) and lack of training (15 percent)," notes Robert W. Hered, MD, in "Children's Eye Screening in the Primary Care Office: Rationale and Methods," referring to a Clinical Pediatrics study.

Newer screening technology using a machine, such as the SureSight Vision Screener, seems to conquer these challenges by providing results faster with an easier method that staff can perform. The instrument automatically screens vision in seconds without requiring the child to respond, according to School Health Corporation, a medical supplier. "The portable unit requires little time to learn; and nurses, technicians, and other trained personnel can administer tests."

SureSight reimbursement information suggests you have two coding options for the equipment. But there's only one solution. "You should choose the code based on which unit you're using," instructs one of the manufacturer's reimbursement specialists.

The breakdown: Healthcare professionals use the SureSight Vision Screener for screening of visual acuity, and you should report it with 99173 (Screening test of visual acuity, quantitative, bilateral), explains Cindy Paddock's assistant at Welch Allyn. You should reserve 92015 (Determination of refractive state) -- the other coding choice SureSight reimbursement information lists -- for auto refraction performed with an autorefractor device, such as the SureSight Autorefractor or Retinomax.

Experts confirm this advice. An auditor working with pediatrics in our area stated that "if our pediatricians used the instrument to screen, her recommendation would be to bill 99173," reports Lynn A. Brown, CPC, director of physician coding and reimbursement for Children's Health System in Birmingham, Ala.

Reporting the screener with 99173 lets you use a common pediatric code. "I'm skeptical about using 92015 because it falls under special ophthalmological services," notes Carrol Kozerinsky, CPC, at THN Physicians Association in El Paso, Texas. Insurers may question pediatricians reporting an atypical pediatric code.

Interpretation of the word "determination" in 92015's descriptor might make you consider using this code. But does it mean screening or treatment? "The code was originally intended for use by eye doctors when determining the correct glasses prescription for their patients," reports Hered, who is also chief of the division of ophthalmology at Nemours Children's Clinic in Jacksonville, Fla.

Do this: Stick with the correction requirement. Taber's Medical Dictionary defines "determination of refractive state" as determination of the amount of ocular refractive errors and their correction. "You determine the treatment needed for the refractive error," explains David Gibson, OD, FAAO, practicing optometrist in Lubbock, Texas.

In fact, Welch Allyn sells the autorefractor unit only "through exclusive ophthalmic distribution." The SureSight Autorefractor "gives more comprehensive, diagnostic results," which "are necessary for eye care practitioners who are prescribing corrective glasses or contact lenses," according to School Health.

Before you fix your vision screening hassles with the SureSight Vision Screener, you've got to research the million-dollar question. "Do payers reimburse?" Kozerinsky asks.

Lowdown: CPT allows you to separately code a screening performed at the time of an E/M service. Therefore, coding guidelines permit you to code a preventive medicine service in addition to a vision screening, such as 99392 (Periodic comprehensive preventive medicine reevaluation and management of an individual ... early childhood [age 1 through 4 years) and 99173.

Reality: Even if you shell out the $4,000+ capital cost for the handheld screener, you're still likely to confront screening payment problems. 2006 Data from Pediatric Physician's Computer (PCC) shows frequent use of 99173. Clients often report the code thousands of times, says Chip Hart, head of Pediatric Solutions at PCC in Winooski, Vt. The average charge, however, is $20.90, with an average payment of $6.64. "The implication is that it is not often paid and, when it is, is paid poorly," he concludes.

Despite confusing information about coding for the SureSight, most of your fellow pediatricians aren't billing it as a refraction -- or have purchased autorefraction equipment consistent with 92015. "Code 92015 is not a common procedure among our clients," Hart says. Payment averages $15.18 for PCC customers.