Current Procedural Terminology (CPT®) guidelines state that preventive medicine codes include the ordering of appropriate immunization(s) and laboratory or diagnostic procedures. However, the administration of immunizations and ancillary or other procedures identified with a specific CPT code are reported separately and are not inherent to the preventive medicine visit.

Although payers are mandated to use the Healthcare Common Procedure Coding System (of which CPT codes are part) and International Classification of Diseases, Ninth Revision, Clinical Modification as their official code sets, they may make their own payment policies. Many payers use proprietary software systems for their claims edit systems and customize them based on their established policies. Two procedures that are routinely and inappropriately denied or bundled are hearing (92551) and vision (99173) screening. The Centers for Medicare & Medicaid Services recently assigned relative value units for hearing and vision screening, which will hopefully assist practices in negotiating...

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