By AOA's Coding Experts, Doug Morrow, O.D., Harvey Richman, O.D., Rebecca Wartman, O.D.
Many practices are developing mechanisms to provide services beyond the comprehensive eye exam. Some are incorporating medical treatments, others specialty contact lenses, but still, in many offices vision therapy and visual processing assessments are a primary mode of practice.
For this last group of doctors, there was a change in CPT® codes used for 2019. The 96000 CPT codes are used by physicians to report the services provided during testing of the cognitive function of the central nervous system. The testing of cognitive processes, visual motor responses and abstract abilities is accomplished by the combination of several types of testing procedures. It is expected that the administration of these tests will generate material that will be formulated into a report.
A physician of any specialty can report these services. The use of developmental screening instruments of a limited nature (e.g., Developmental Screening Test II, Early Language Milestone Screen, Parents' Evaluation of Developmental Status, Ages and Stages, and Vanderbilt attention-deficit/hyperactivity disorder rating scales) is reported using CPT code 96110, developmental testing; limited. Code 96110 is often reported when performed in the context of preventive medicine services, but may also be reported when screening is performed with other E/M services such as acute illness or follow-up office visits. A trained nonphysician personnel performs this service; this code does not include any physician work. The review of the screening results is included in the preventive or E/M service. Questions asked by a physician about a child's development, as part of the general history, are not a formal measure as such and are not separately reportable. Each administered developmental screening instrument is accompanied by an interpretation and report (e.g., a score or designation as normal or abnormal). Physicians are encouraged to document any interventions or referrals based on abnormal findings generated by the formal screening. If several tests are administered, results may be combined into a single report. Recommendations for interventions and other supportive measures should be included in the report summarizing the test results.
When developmental surveillance or screening suggests an abnormality in a particular area, more extensive formal objective testing is needed to evaluate the concern and an order should be created and documented in the chart. Subsequent periodic formal testing may be needed to monitor the progress of a child whose skills initially may have not been significantly low, but who was clearly at risk for not maintaining appropriate acquisition of new skills.
These longer, more comprehensive developmental assessments using standardized instruments were previously reported using CPT 96111. In 2019, 96111 was deleted, but there are two new codes for these services. CPT 96112, developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour and 96113, developmental test administration; additional 30 minutes (list separately in addition to code for primary procedure) are to be used when appropriate. These are tests of development, typically performed by physicians or other specially trained professionals, for which the physician work is included as part of the service.
For more information, review the updated Vision Therapy and Neuro-rehabilitation: Optometric Considerations in Third Party Reimbursement resource.
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Evaluation and management (E/M) services are incredibly important in patient care, and it’s critical that optometry practices are aware of changes ahead. Meanwhile, the AOA and other leading physician organizations are pushing legislation that would halt Medicare payment cuts resulting from the changes.
Time to review your practice’s billing and coding: Access national benchmark data for optometry practices and join an upcoming webinar to learn more about E/M code changes in 2021.