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Pediatric Coding Alert

Reader Question:

Research State Visual-Acuity Test Requirements

Published on Sun Sep 28, 2003

Question: When I report CPT 99173 with 99382-99383 or 99392-99393, Medicaid denies the screening test. Should I appeal the denial?

Kentucky Subscriber Answer: Kentucky Medicaid will not pay for a vision screening with any other E/M code. For the carrier to cover 99173 (Screening test of visual acuity, quantitative, bilateral), your pediatrician must perform the screening test only and provide the preventive medicine service (99382-99383, Initial comprehensive preventive medicine evaluation and management of an individual ...; 99392-99393, Periodic comprehensive preventive medicine re-evaluation and management ...) on a separate visit. You should work with your state Medicaid board to cover 99173 with a preventive medicine service.

Remember: Medicaid 99173 coverage is a state-specific issue, so the bundle doesn't affect all pediatric coders.
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