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Thread: 99173 Vision Screening

  1. #1

    Question 99173 Vision Screening

    Hi, I was wondering if anyone else is having problems with the 99173 when billed with a well exam. I went to a doctors coding conference where they said this is payable and should be billed with a mod-25 on the visit. I have been doing this and get one of these three things:

    Denied, pt has no vision screening coverage in policy, pt responsibility or
    Paid or
    Denied, cannot be billed along with a well visit.

    I am truly confused here. AND, I get all of the above from the same company! How can it be all of them? Can I appeal if it is the third reason?

    I hope someone can shed some light on this for me.

    Thanks so much

  2. #2
    Join Date
    Apr 2007
    Location
    Chicopee, MA
    Posts
    108

    Default

    It is appropriate to bill separately for this per CPT Guidelines. Under the Preventive Medicine section it says: "Immunizations and ancillary studies involving laboratory, radiology, other procedures, or screening tests identified with a specific CPT code are reported separately."

    But, the payor you are dealing with may have a specific policy in place that says otherwise.

    So, I'd look in the provider manual (check online, many payors now have their policies published online) or as your provider rep. If they don't have a written policy in place, then you can try to appeal citing the CPT guidelines.

    In the cases where the benefit is not covered under the member's plan, there's nothing you can do about that. It is a good idea to check benefits before the visit and collect upfront. The parents may not even realize the vision screen is not included in the physical.

    Hope that helped! Good luck!

    Erica

  3. #3
    Join Date
    Apr 2007
    Location
    Alexandria, VA
    Posts
    383

    Smile

    Quote Originally Posted by kendallg View Post
    Hi, I was wondering if anyone else is having problems with the 99173 when billed with a well exam. I went to a doctors coding conference where they said this is payable and should be billed with a mod-25 on the visit. I have been doing this and get one of these three things:

    Denied, pt has no vision screening coverage in policy, pt responsibility or
    Paid or
    Denied, cannot be billed along with a well visit.

    I am truly confused here. AND, I get all of the above from the same company! How can it be all of them? Can I appeal if it is the third reason?

    I hope someone can shed some light on this for me.

    Thanks so much


    OK....I don't know ANY insurance company that pays for this cpt code w/a well exam....I have been billing/coding for a long time...lol

    However, if a Eye Doctor does it; it is covered....

    YTH, CPC

  4. #4
    Join Date
    Apr 2007
    Location
    San Diego
    Posts
    163

    Default

    Hi,

    The following is info I found regarding your code:

    A CPT code 99173 may be reported separately when other identifiable services unrelated to this screening test (e.g., preventive medicine services) are provided at the same time. However, 99173 may not be reported separately when acuity is measured as part of a general ophthalmologic service or an E/M service of the eye, because the test is then considered diagnostic rather than screening.
    http://www.aafp.org/fpm/20020600/coding.html

    I also remember reading up on this code on the NHIC/Medicare website and there were several caveats to billing for it. Such as, time restrictions (couldn't be billed within a certain time period of an e/m or ophth code) and other "restrictions".

    I hope this info helps...I know it's limited. I work for an ophthalmologist. Email me if you have any more questions and I'll see what I can find.
    Sylvia Thompson, CPC
    Billing Supervisor
    San Diego, CA

  5. #5

    Default Thank you

    I really appreciate all the replies. I am still learning and for as much as you 'think' you know there is still so much more I don't know! LOL

    I have been coding for two years but never dealt with the posting of EOB's so I never knew unless I was told what was getting paid or not, etc. Now I am doing that part too and have A LOT to learn.

    I did go online last night and read through all the policies. Thanks for that info Erika, I didnt even know I could get them online! They all differ and only one pays.

    Now I know at least which ones to collect upfront.

    Thanks again for the help.

    K

  6. #6
    Join Date
    Apr 2007
    Location
    Alexandria, VA
    Posts
    383

    Thumbs up

    Thanks for the add'l info on this code and the website.....


    YTH,CPC

  7. #7

    Default

    Sylvia,

    Do you remember where you saw the info regarding the timing of billing the 99173? I'm looking for any info that can help with locating how often a 99173 can be billed, etc.

    Any help would be greatly appreciated

  8. #8

    Default Aetna Pays

    FYI, I get paid by Aetna for a 99173 with a preventative exam. It's only $2.05, but hey it's something.

    UPDATE: I kept getting a denial on this from BCBS saying "charges exceed multiple service priced amount". I called and asked the rep what that means and she wasn't sure. She looked into it and said there was no bundling edit for this code so they reprocessed it and paid $3.47 on each of them. I haven't quite figure out if i will just hold them until the end of the month and call on everything at once from here on out or what. But the rep seems to think it shouldn't have happen again. I don't have much faith that that is true, but at least we got paid something.
    Last edited by tamara.battle; 10-27-2009 at 05:24 PM.

  9. #9

    Cool vision test

    Quote Originally Posted by kendallg View Post
    Hi, I was wondering if anyone else is having problems with the 99173 when billed with a well exam. I went to a doctors coding conference where they said this is payable and should be billed with a mod-25 on the visit. I have been doing this and get one of these three things:

    Denied, pt has no vision screening coverage in policy, pt responsibility or
    Paid or
    Denied, cannot be billed along with a well visit.

    I am truly confused here. AND, I get all of the above from the same company! How can it be all of them? Can I appeal if it is the third reason?

    I hope someone can shed some light on this for me.

    Thanks so much

    It is our experience in Richmond, VA that the response to the vision test is based on whether or not the patient has preventive med coverage. If they do, the payer tends to bundle the vision test with the preventive med visit. If they don't they pay for both individually but this generates a co-insurance to the patient. The -25 modifier on the visit has not made a significant difference, however, separate diagnosis have. We code V20.0 for the visit and V72.0 for the test.

    Miguel

  10. #10

    Question Cpt 99173

    How to reimburse 99173 CPT code with Preventive visit code 99394, if our Dr. specialty is internal medicine? Insurance is denying cpt 99173 giving reason wrong facility?

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