Pediatric Coding Alert

Question: Should I use 0065T instead of 92015 for a SureSight vision screening?


New Mexico Subscriber
Answer: No. The screener is classified as a refractive tool (92015, Determination of refractive state), not photoscreening (0065T, Ocular photoscreening, with interpretation and report, bilateral). The manufacturer's Web site indicates that acceptable codes for the Suresight Vision Screener include 92015 and 99173 (Screening test of visual acuity, quantitative, bilateral).

Don't expect payment for the screening. Although "Use of the SureSight in the physician office is usually covered by private payers [and Medicaid] when medically necessary," payment varies by payer, plan, and provider contract, according to Welch Allyn's reimbursement brochure available at www.welchallyn.com/medical/support/reimburse/SM2614%20Rev.B_SureSight%20Reimbursement.pdf. Possible nonpayment reasons include:

1. Some payers may impose restrictions on 92015 based on physician specialty.

2. Payers may consider 99173 a bundled service and include the screening as part of a same-day office visit or preventive medicine service.

Reserve 0065T for sequential photoscreeners (such as the MTI Photoscreener or the Visiscreen 100), or miniature, digital flash cameras (such as The Gateway DV-S20) that detect a defect in a child's eye without the need of a response from the child during screening. The new technology devices capture images of the pupillary reflexes and red reflexes, sending them to an evaluator.