Pediatric Coding Alert

Question: Can you explain the difference between visual screening codes 99172, 99173, and 99174/99177? Which one(s) should we be using for the vision screenings we perform during child well visits?

Florida Subscriber

Answer: CPT^® code 99172 (Visual function screening, automated or semi-automated bilateral quantitative determination of visual acuity, ocular alignment, color vision by pseudoisochromatic plates, and field of vision (may include all or some screening of the determination[s] for contrast sensitivity, vision under glare)) is a code for vision screenings performed in occupational medicine on adults in professions that require excellent sight or where there are vision safety standards. So, it is unlikely you would use this in a pediatric context.

CPT^® code 99173 (Screening test of visual acuity, quantitative, bilateral), on the other hand, is very typically used for pediatric vision screenings. Per the CPT^® instructions for the code, providers usually perform this screen using a Snellen chart, the familiar eye chart that features letters in rows of descending size.

Coding alert: Also, per CPT^® instructions for the screening test, “other identifiable services unrelated to this screening test provided at the same time may be reported separately (eg, preventive medicine services). That would include annual well-visit services reported with 99381/99391 (Initial/Periodic comprehensive preventive medicine evaluation/reevaluation and management of an individual …).

CPT^® codes 99174 (Instrument-based ocular screening (eg, photoscreening, automated-refraction), bilateral; with remote analysis and report) and 99177 (…with on-site analysis) are also used in pediatrics, especially with preverbal, nonverbal, or noncooperative patients. The service involves using a device that takes images of the child’s eye to screen for any abnormal conditions. You would report 99174 if your office transmits the images from the test to an outside interpreter, and 99177 if you perform the interpretation in-house.