Posts tagged with vision screening

Back on one of the coding lists, a brave soul asked:

I am curious to know what you are being paid for these. To avoid any questions, please don

Back on one of the coding lists, a brave soul asked:

I am curious to know what you are being paid for these. To avoid any questions, please don't tell me the name of the carrier and what they pay......I would greatly appreciate knowing the range of PPO reimbursements for vision and hearing?

I was curious myself and these codes were next on my list to look at, so off I went. I begin with the 99173, "Vision Acuity Screening." In 2008, it clocks in at - get this - .07 RVUs (no typo), or about $2.60-something in taxpayer dollars. I suppose I shouldn't complain, as it only received RVUs in 2007...before that, it was 0.

With a little help from Igor, I computed the average charge and reimbursement for each of the many modifier permutations our clients used from 2005 through 2007. Normally, I might lump them all together, but I noticed some important trends we should consider. Click on the graph below to zoom in on the results.

What do we learn? There is been a slight decrease in overall 99173 reimbursement since 2007, but that $9.04 our clients received in 2007 (very last columns) is worth millions to them across the country. Two other important items:

• -25 modifier usage, once very popular, has always been reimbursed at a lower rate and it's declining rapidly.
• -51, -52, -59 modifier usage makes a big difference. Other than the "vanilla" 99173 itself, the -59 modified version is the most popular (does anyone want a distribution graph showing modifier usage? Just ask...). The implication is that using the -59, appropriately, may lead to an increase in well earned income. Like the 90471 vs. 90465 discrepancy, this might be an opportunity to fix your coding.

A little while ago, someone bravely asked to see 99174 usage data among pediatricians.

For those who aren't family, the 99174 is new in 2008. To quote the CPT book (but not enough to attract the ire of the AMA), the 99174 is "Ocular photoscreening with interpretation and report, bilateral."

So, waltzing into the massive PCC database, we find...no instances of the 99174 among our clients. None, zippo, nada. That doesn't help! Therefore, I turn to the new poll on the left. Anyone here using the 99174? Getting paid? Tell us more. The code itself is scheduled to get more/better RVUs in 2009, so perhaps it's time to pay attention.

Thanks.

In my final installment from Bonnie regarding screening payment challenges, here is a sample Vision Screening Waiver used in a Real Live Pediatric Practiceâ„¢ with success. We have already reviewed an Audiogram Appeal Letter and a Typanometry Appeal Letter. Here is the document you can use to pre-empt all the trouble.

As before, the text is below, but you can also download it in OpenOffice, PDF, or Word format.

Your Practice Name

Address

City, State ZIP

Phone Number

VISION SCREENING

Patient Name: ________________________________________________

Every child needs a periodic vision examination, which something we provide here in our office. Your insurance company might pay part of the fee for an ophthalmologist or optometrist to check your child's eyesight, but you will likely have a co-payment. Insurance Companies often will not pay us for the vision screen but you have already paid your co-payment.

We care for you and your children, but just like the ophthalmologist and optometrist, we have expenses and cannot provide this service for free. We will provide this service for our standard fee or you may take your child to an optometrist or ophthalmologist instead. Our fee of $X0.00 compares to an average Optometrist fee of $X+0.00 or even an Ophthalmologist fee of $X+++ to $X++++ per visit. Even if you are covered, you will probably have a co-payment.

We are more convenient as you are already here and we do a good job but, we respect and support your choice. Please understand that if we provide this service and your insurance carrier elects not to pay us then you will be held responsible for the standard fee listed above.

Please select from the following choices:

_____ Please check my child's vision at today's visit. I understand I am responsible for the $30.00 fee if by chance my insurance carrier does not cover this service.

_____ I do not wish for my child's vision to be checked at today's visit. I will take my child to an Ophthalmologist or Optometrist soon.

Parent Signature: ___________________________ Date: __________

Enjoy - and thanks again to our friends in San Antonio! Obviously, if anyone else has appeal letters or waivers they'd like to share (with or without attribution/credit), send them along.