Pediatric Coding Alert

"The addition of two new vision screening codes 99173 in 2000 and 99172 in 2001 has caused confusion among some pediatricians concerning which code should be used under which circumstances. Although the American Academy of Pediatrics (AAP) strongly recommends pediatric vision screenings, and has lately received a grant from the federal government to combat barriers to such screening, only 21 percent of preschool children are screened for vision problems. To offer this service to patients, however, pediatricians need to know how to code correctly and be paid for the exam.

The most appropriate code to use for vision screening in primary care pediatrics is 99173 (screening test of visual acuity, quantitative, bilateral [The screening test used must employ graduated visual acuity stimuli that allow a quantitative estimate of visual acuity (e.g., Snellen chart). Other identifiable services unrelated to this screening test provided at the same time may be reported separately (e.g., preventive medicine services). When acuity is measured as part of a general ophthalmological service or of an E/M service of the eye, it is a diagnostic examination and not a screening test.]). The correct ICD-9 code for 99173 is V72.0 (examination of eyes and vision).

Avoid 99172

CPT 2001 has added a second visual screening code, 99172 (visual function screening, automated or semi-automated bilateral quantitative determination of visual acuity, ocular alignment, color vision by pseudoisochromatic plates, and field of vision [may include all or some screening of the determination(s) for contrast sensitivity, vision under glare] ... [This service must employ graduated visual acuity stimuli that allow a quantitative determination of visual acuity (e.g., Snellen chart). This service may not be used in addition to a general ophthalmological service or an E/M service]). This code is for visual function screening, but it is not for use by pediatricians in screening children for developmental visual problems. The code was requested by occupational medicine practitioners, and is for use only in screening pilots and other professionals whose vision abilities are imperative to job requirements.

Bill Vision Screen With Preventive Medicine Codes

Code 99173 may be billed along with the preventive medicine codes (99381-99385 and 99391-99395) to ensure adequate reimbursement for vision screenings. For example, a 3-year-old established patient comes in for a checkup (99392, periodic preventive medicine re-evaluation and management of an individual including a comprehensive history, comprehensive examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate laboratory/diagnostic procedures, established patient; early childhood [age 1 through 4 years]). If the pediatrician performs a vision screening during the check-up, he or she may bill 99173 in addition to 99392. You do not need to [...]