Local Chapter Officer
Alvin, TX
Best answers
I have a question about 99172. According to the CPT guidelines 99173 cannot be billed with 99172. I get that, my question is what about 92081 and 92283? Aren't these encompassed within 99172?
Are you talking about billing and coding these in a pediatric office or an optometry/ophthalmology practice?

If in a pediatric office, why don't you refer these patients to an optometrist or ophthalmologist for a more comprehensive exam versus bits and pieces of an exam? Simple screening tests often miss refractive or pathological problems especially in children.

I would be very leery of billing either a color vision or visual fields code in a PCP/pediatric practice.

Tom Cheezum, O.D., CPC
not pediatric

Actually, I do not code for a regular medical practice. I code for the DOD. I am just trying to understand what codes such as 99172 and 92283 involve as I have physicians in Flight Medicine trying to code them for flight physicals and so forth, but I am not positive they are doing the correct procedure for the code. I have tried to research the codes and have not found good layman terms for the codes. Do you have any suggestions where I might find solid descriptions for the above codes. And yes, I am aware that you do not bill some of these codes together with E&M's in the civilian world, but in the Military world the encounter does not go anywhere so we code almost any and all procedures together.
Any help you could provide would be greatly appreciated.
Here is some information I found on the code from a 2001 article. Note when you read the section on the 99172 code that it says it was requested by Occupational Medicine and should only be used when screening pilots and other occupations where good vision is critical.

Tom Cheezum, O.D., CPC

The most appropriate code to use for vision screening in primary care 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 correct ICD-9 code for 99173 is V72.0 (examination of eyes and vision).

Avoid 99172

CPT 2001 has added a second visual screening 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] ... [This service must employ graduated visual acuity stimuli that allow a quantitative determination of visual acuity (e.g., Snellen chart). This service may not be used in addition to a general ophthalmological service or an E/M service]). This code is for visual function screening, but it is not for use by pediatricians in screening children for developmental visual problems. The code was requested by occupational medicine practitioners, and is for use only in screening pilots and other professionals whose vision abilities are imperative to job requirements.
So what you are saying is that since I code for the Air Force, and we do physicals and screenings on pilots all the time, that this code was specifically made for them and long as it is not coded with E/M, this is a good working code for them. And as long as the documentation shows the screened for color, visual acuity and field of vision?
Let me ask this please, Say we have a physical and during that physical the pseudiosochromatic color vision test, visual acuity test and the Amlser Grid field of vision test is all done. Is the only code possible to code the 99173? Because I cannot find anything that would cover the other two.
99173 only covers visual acuity testing whereas 99172 covers visual acuity, color vision and visual field testing.
For the visual field test, I think that, in addition to the Amsler grid which is only for the central 10 degrees of field, you should also be doing a "finger count" peripheral field screening to be complete, especially if these are for flight physicals.

Therefore, you should, IMHO, be coding 99172 in your situation.