Pediatric Coding Alert

Many pediatric practices conduct vision screens, but dont know how to code for extra reimbursement to account for their time to provide this valuable service. Lori Rini, office manager for Village Pediatrics of Garden City, NY, sends in this question: Can pediatricians bill (and be reimbursed) for the vision screen procedure? We are currently using the CPT code 92020, which is not reimbursed.

Actually, 92020 is for gonioscopy, a specialized ophthalmogical procedure, not for normal vision screens.

And, in fact, there is no special procedure code for a vision screen which is not conducted by an ophthalmologist. I dont think they (pediatric practices) can get reimbursed, says Mary Bowles, office manager for O.B. Jackson, MD, a pediatric ophthalmologist in Austin, TX.

The code an ophthalmologist would use is 92002 for a new patient, and 92012 for an established patient, says Bowles. But these codes are only supposed to be used by ophthalmologists.

Bowles recommends using an office-visit code, perhaps a CPT 99212 , and documenting the vision screen procedure and why it was done. They also might be able to bump it up a code, maybe even to a 99213, she says, depending on the extent of the exam.

Deborah Christian, billing supervisor for Delaware Valley Pediatrics, a four-pediatrician, two-nurse practitioner practice in Lawrenceville, NJ, also recommends using 99212. If they come in because the school says the child seems to have a vision problem, and theyve already previously had their annual physical, we would do the eye exam and code it 99212, she tells us. For the diagnosis code, we would use 368.9 (unspecified visual disturbance).

Usually, vision screens are done as part of the childs annual check-up unless specifically indicated, says Christian of her practice. However, if it is done at the annual exam, we dont bill additionally for it, she explains. Its billed as a part of the physical.