Pediatric Coding Alert

Question: How do we get reimbursed for hearing and vision screens done during a well visit? Most insurance companies are telling us theyre bundled in.

New Jersey Subscriber

 
Answer: The insurance company that refuses to pay is wrong. In the introduction to the preventive-medicine services section (99381-99397), CPT says procedures that are identified with a specific CPT code should be reported separately from the preventive-medicine services codes themselves. Furthermore, the screening-test descriptor for vision refers to the appropriateness of billing separately for other services, citing specifically preventive-medicine services.
 
The code for billing vision screening, introduced in CPT 2000 after much work by the American Academy of 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 code for hearing screening is 92551 (screening test, pure tone, air only).
 
But your contract might not take CPT into account. You should know whats in your contract. If it says the carrier bundles these codes with well visits, and you signed it, you dont have much to go on when you appeal denials. Send a copy of the CPT introduction to the preventive-medicine services section to the payer and ask it to rethink that bundle. Also, when you renew contracts or sign new ones, make sure 99173 and 92551 are not bundled into preventive-medicine services.