Screening at well visits

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If the vision and hearing screening are done as part of a wellness visit we use Z00.129 and have never had a problem with reimbursement. I know some payers have guidelines as to what they want you to use.
 

mmiele1979

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I'm looking for the answer to this too and the above isn't helpful bc its two conflicting answers with zero clarification. Anyone with any clarification? This seems to be payer specific as well. I have come across payers that do not want to pay for a hearing/vision exam and say that it's not considered preventative. Depends on the age of the child. If we get that kind of denial is it then ok to unbundle it and send it in with a corrected claim linking it to the appropriate encounter for hearing/vision exam code? We are adding a 33 to each code as well. Is this necessary?
 

prusso

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I'm looking for the answer to this too and the above isn't helpful bc its two conflicting answers with zero clarification. Anyone with any clarification? This seems to be payer specific as well. I have come across payers that do not want to pay for a hearing/vision exam and say that it's not considered preventative. Depends on the age of the child. If we get that kind of denial is it then ok to unbundle it and send it in with a corrected claim linking it to the appropriate encounter for hearing/vision exam code? We are adding a 33 to each code as well. Is this necessary?
Did you ever get an answer to your question? I have searched everywhere to get some type of answer. Everything says that the Z01 codes are only when the visit is for nonscreening visits. At every prev exam the provider is doing the exam, eye, hearing, and other items however the eye and hearing are hit or miss and I can't find a pattern as to why they will sometimes pay and sometimes not pay. Even the ages don't seem to be consistent. Amerigroup is one of our worst payors and I keep emailing the provider rep and they still won't answer. I wish there was a page where it just said each payor and how each one wants it coded lol.
 

thranowski

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Did you ever get an answer to your question? I have searched everywhere to get some type of answer. Everything says that the Z01 codes are only when the visit is for nonscreening visits. At every prev exam the provider is doing the exam, eye, hearing, and other items however the eye and hearing are hit or miss and I can't find a pattern as to why they will sometimes pay and sometimes not pay. Even the ages don't seem to be consistent. Amerigroup is one of our worst payors and I keep emailing the provider rep and they still won't answer. I wish there was a page where it just said each payor and how each one wants it coded lol.
Hello, I have been coding in pediatrics for over a decade. The way I do it is to use Z00.121/9 as the primary DX for each line item, and then the screening code as the 2ndary dx. If there is an abnormal result, I will add a 3rd problem dx if one is available. The only one I don't use is the maternal depression screening ICD10 because some payers reject it based on gender, even though the CPT regards the mother. On the CRAFFT, you only use Z00.121/9. I always use modifier 25 on the E&M and 59 on the procedures. It depends on the payer if you will get reimbursed for any additional procedures, but it doesn't cost anything to put it on the claim so I always do.
 

prusso

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Hello, I have been coding in pediatrics for over a decade. The way I do it is to use Z00.121/9 as the primary DX for each line item, and then the screening code as the 2ndary dx. If there is an abnormal result, I will add a 3rd problem dx if one is available. The only one I don't use is the maternal depression screening ICD10 because some payers reject it based on gender, even though the CPT regards the mother. On the CRAFFT, you only use Z00.121/9. I always use modifier 25 on the E&M and 59 on the procedures. It depends on the payer if you will get reimbursed for any additional procedures, but it doesn't cost anything to put it on the claim so I always do.
Are these screening codes including the eye and hearing screenings such as cpt 99177, 99173 and 92558. Especially 92558 they keep denying for diagnosis and for the life of me I cant figure out what they want. What do you use for an icd10 on a normal screening for the 92558?
 

wlf78911

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Hello, I have been coding in pediatrics for over a decade. The way I do it is to use Z00.121/9 as the primary DX for each line item, and then the screening code as the 2ndary dx. If there is an abnormal result, I will add a 3rd problem dx if one is available. The only one I don't use is the maternal depression screening ICD10 because some payers reject it based on gender, even though the CPT regards the mother. On the CRAFFT, you only use Z00.121/9. I always use modifier 25 on the E&M and 59 on the procedures. It depends on the payer if you will get reimbursed for any additional procedures, but it doesn't cost anything to put it on the claim so I always do.
I am totally agreed with you, i have been doing pediatric coding and billing for over a decade as well.
 

thranowski

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Orlando, FL
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Are these screening codes including the eye and hearing screenings such as cpt 99177, 99173 and 92558. Especially 92558 they keep denying for diagnosis and for the life of me I cant figure out what they want. What do you use for an icd10 on a normal screening for the 92558?
Sorry for late response I didn't see this. I'm not sure if you're using the correct codes.

99177 is for when you do the photoscreening with the picture of the eyes and there is someone on site who reviews it. If you are using a program that reads it (like iScreen), it is 99174. Insurances generally don't pay for this, so we have our patients sign an ABN that we file first and if they don't pay, they owe us $20 (or whatever amount you want to charge) because we have to pay the company per test.

We don't bill 92558, that is a specialized machine that measures the sound or something like that. We use 92551 which is when you put the machine to their ear and it beeps, and they tell you if they hear it.

For 99173 and 92551, some insurances cover it, some don't. Half the time it gets sent to patient deductible.
 

lisamilo

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What documentation are you requiring from your providers for billing 92551 Hearing screening and 99173/99174 vision screenings. The measurements for each test?
 

thranowski

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Orlando, FL
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What documentation are you requiring from your providers for billing 92551 Hearing screening and 99173/99174 vision screenings. The measurements for each test?
Sorry I never saw this. For all tests the nurse performs them and documents the results in the chart note. There is an order for each test that she puts the results in too, and then the doctor signs off on the orders. If we do the vision screen with the machine, the nurse saves the PDF file and attaches it to the order as well.
 

kmink

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Does anyone know about the ED setting for facility requirements for reporting a CPT code for vision screening? Can the hospital ED report the vision screen CPT code if it is completed by a nurse in a Pediatric ED?
 
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