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New language makes challenging screening bundles easier.

If you-ve been lumping immunization and ancillary services into preventive medicine services, you may have been shorting your practice.

"We always felt the guidelines had been clear but apparently they were misunderstood," noted Peter A. Hollman, MD, AMA CPT editorial panel vice chair in the "Evaluation and Management Services" session at the CPT and RBRVS 2009 Annual Symposium in Chicago. "They-re very clear now."

Here's the skinny on which items you should separately report.

Do Well Check Codes Include Vaccine Services?

Because CPT 2008's preventive medicine services codes referred to ordering of "appropriate immunization(s)," some insurers thought 99381-99397 included the vaccine product and administration. To eliminate this confusion, the AMA revised 99381-99397 to exclude the reference to ordering of "appropriate immunization(s)."

CPT also spells out preventive medicine associated services that are exclusive of 99381-99397. "Vaccine/toxoid products, immunization administrations, ancillary studies involving laboratory, radiology, other procedures, or screening tests [e.g., vision, hearing, developmental] identified with a specific CPT code are reported separately."

Should I Count 96110 as Part of 99381-99397?

Note that the revised guidelines include examples of types of screening tests that should be reported separately from preventive medicine service codes. That means, if a non-Medicare patient receives a vision screen, a hearing screen, or a developmental screen at a preventive medicine service, you would code the E/M, plus each screening. Here's how:

- If the staff uses a Snellen chart, SureSight Vision Screener, or other instrument to test a patient's visual acuity, you would report 99173 (Screening test of visual acuity, quantitative, bilateral).

- For a hearing screening involving pure tone audiometry (at a single decibel level), use 92551 (Screening test, pure tone, air only).

- When staff, the patient, or the patient's family answer questions using a standardized screening instrument, and the physician interprets the results, you should assign 96110 (Developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report).

Example: Prior to the FP performing a 4-year-old established patient's preventive medicine service, a nurse uses a Snellen chart to test the child's visual acuity and pure tone audiometry to test the child's hearing. A parent completes the Parents- Evaluation of Development Status (PEDS), which screens for developmental delays. A nurse places the answer sheet on the front of the patient's chart.

The FP scores and reviews the forms. The physician asks some additional questions of the mom and confirms that the screens are "normal." The FP discusses the normal screen with the parent.

The FP also performs the preventive medicine service.

The claim should contain the following codes:

- 99392 (Periodic comprehensive preventive medicine reevaluation and management of an individual ...; early childhood [age 1 through 4 years]). Although CPT does not require modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) on a same-day E/M service with a medicine code, some insurers require the modifier to indicate the screens are significant and separate from the preventive medicine service.

- 92551 for the hearing screening

- 99173 for the vision screening

- 96110 for the administration and review of the PEDS screen

- V20.2 (Routine infant or child health check) as the diagnosis code.

How Can I Challenge Denials?

Tired of fighting for screen coverage on a preventive medicine service claim? Having specific black-and-white language in CPT 2009 will be very helpful in pursuing payment from insurers, experts assure.

"We-ll now have notes to copy and submit from CPT that clearly state the well check does not include the screening," notes Deanna Wolfgram, physician coding educator for Beloit Clinic in Beloit, Wis. Add this additional support to your appeals packet.