Pediatric Coding Alert

This amblyopia screening tool has its own codeIf you want to test nonverbal patients for visual impairments, you may want to consider a visual evoked potentials machine that insurers often cover per test from a low of $30 to a high of $160.Although payment for vision screening (99173, Screening test of visual acuity, quantitative, bilateral) can prove hard to come by, reimbursement is much more straightforward for VEP test code 95930 (Visual evoked potential [VEP] testing central nervous system, checkerboard or flash). Instead of the SureSight Vision Screener (99173), "I use the VEP machine (95930)," says Richard Lander, MD, FAAP, a pediatrician at Essex-Morris Pediatric Group in Livingston, N.J. "It is a good screening test for amblyopia that is able to test kids as young as 6 months old."Test Nonverbal Children With Staff-Run TestThe American Academy of Pediatrics Bright Futures evidence-based age-specific guidelines recommend that children have an early childhood vision screen at age 3 or 4 years. And the U.S. Preventive Task Force, an independent panel of experts in primary care and prevention that reviews the evidence of effectiveness and develops recommendations for clinical preventive services, recommends screening to detect amblyopia, strabismus and visual acuity defects in children younger than 5 years of age.Benefit: A VEP machine, such as the Enfant Pediatric Vision Testing System manufactured by Diopsys, lets you detect visual deficits, such as optic nerve disorders, asymmetric refractive errors, and other problems that could lead to amblyopia in children who can't tell they have visual problems.The child may be preverbal or unreliably tested with subjective vision tests, says Diane C. Fulton, director of insurance/medical coding and billing for Diopsys Inc. in Pine Brook, N.J. Or with older children, the patient may not recognize that he has a problem because his sight seems "normal" to him.VEP testing provides the doctor with an objective assessment of a child's vision for appropriate referral, diagnosis and treatment. "It's just not practical to send every child to a specialist for a test that the patient's pediatrician can do," Fulton says. "This test makes a difference in children's lives by catching vision problems that could affect their development at a time when they are most receptive to treatment."Easy: A physician extender can run the test, which has Federal Drug Administration approval for children ages 6 months to 8 years. The machine requires no technical certification. Diopsys provides complete training on the test's use.Expect Payment Most of the TimeCPT contains 95930 for VEP. Insurers reimburse the test 80 percent of the time, depending on your payer mix and geographic area, Fulton says.The estimated 20 percent of payers that reject 95930 coverage usually do so due to contractual issues. "The insurer doesn't want to add [...]