Pediatric Coding Alert

u Caution: Product info could misdirect you to 92015 If you're considering replacing technically difficult and time consuming Snellen eye chart testing with new technology equipment, weigh these pros and cons. Pro 1: Save Time With Handheld 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." Pro 2: Stick With Common Pediatric Code 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. Con 1: Realize 92015 Requires Treatment 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" [...]