[Ohioaap-practicemanagers] payment for vision screening

[Price, Jonathan]

?Instrument based vision screening has been a perennial problem with many payers. The Pediatric Council would like to hear what payers if any are paying for this. The core problem is that the AMA committee that assigns RVUs (Relative Value Units) has assigned an RVU of zero for this service for Medicare patients. Obviously this is inappropriate for children, but is claimed as a reason for it not to be paid.

  Nonetheless, good coding practice and the impetus for change is for providers to code for it and charge for it anyway and appeal whenever it is denied or bundled into a well visit. The AAP members-only website (where you log into MyAAP) has in the past in their practice advocacy section had a template of an appeals letter for this. If it is no longer there, let me know and we can ask the AAP to re-post it.

   Jon Price MD FAAP

   Ohio Chapter AAP Pediatric Council Co-chair





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From: Ohioaap-practicemanagers <ohioaap-practicemanagers-bounces at lists.deltaforce.net> on behalf of Melanie Farkas via Ohioaap-practicemanagers <ohioaap-practicemanagers at lists.deltaforce.net>
Sent: Wednesday, September 27, 2017 4:13 PM
To: ohioaap-practicemanagers at lists.deltaforce.net
Subject: Re: [Ohioaap-practicemanagers] payment for vision screening

[External Email]
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And an additional message from Dr. Michael Chamberlin, that was also caught in the bounce filter:


Jon,

For us, Cigna and Aetna pay the 99173.  You bring up a good point.  What about instrument based vision screening?  Are people being paid for that?  If so, is it applied to deductible or otherwise deemed patient responsibility?

Thanks,

Mike


From: Ohioaap-practicemanagers <ohioaap-practicemanagers-bounces at lists.deltaforce.net> on behalf of PM Listserv <ohioaap-practicemanagers at lists.deltaforce.net>
Reply-To: Melanie Farkas <MFarkas at ohioaap.org>
Date: Wednesday, September 27, 2017 at 4:12 PM
To: PM Listserv <ohioaap-practicemanagers at lists.deltaforce.net>
Subject: Re: [Ohioaap-practicemanagers] payment for vision screening

Forwarding a response from Dr. Jon Price that was caught in the bounce filter for some reason!

?Now I'd like our listserv to tell us if anyone IS paying for it. SOAPM lsitserv's first response it that this version of vision screening (Snellen chart, etc, not instrument-based) is usually bundled by payers, though we know it has a distinct RVU of 0.09. Maybe because Medicare doesn't cover it, payers are following their lead.
   We should find out if any payers are paying.
  Meanwhile, generally consistent coding/billing advice is to continue to put services on claim forms, even if not paid.
    Jon Price



From: Ohioaap-practicemanagers <ohioaap-practicemanagers-bounces at lists.deltaforce.net> on behalf of PM Listserv <ohioaap-practicemanagers at lists.deltaforce.net>
Reply-To: Michael Chamberlin <mikechamberlinsoapm at gmail.com>
Date: Wednesday, September 27, 2017 at 10:23 AM
To: SOAPM <SOAPM at listserv.aap.org>, PM Listserv <ohioaap-practicemanagers at lists.deltaforce.net>
Subject: [Ohioaap-practicemanagers] payment for vision screening

Over the last several years, we are having more problems getting paid for vision screening (99173) at our well child visits.  We have tried billing this code with different modifiers, but nothing seems to work.  It has been a problem with most ins cos (Anthem, UHC, Humana, Med Mutual, OH Caresource, etc).

Is it just us or are you having the same problem?  Any good solutions to this that you have discovered?

Thanks in advance for your help,

Mike


--
Michael Chamberlin, M.D., FAAP
Pediatric Assoc. of Mt Carmel
4371 Ferguson Dr
Cincinnati, OH  45230
513-752-3650
513-752-3387 (fax)

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