Pediatric Coding Alert

Most pediatricians perform developmental screening as a part of well visits. But a new AAP policy statement urging more widespread and in-depth screening for developmental disabilities has pediatricians wondering how to code for such services. The policy, issued in July by the Committee on Children With Disabilities, recommends the use of developmental screening instruments during the first five years of life.
 
Whether you can bill extra for these services depends on why you perform the screening, says Charles A. Scott, MD, FAAP, who practices with Medford Pediatric and Adolescent Medicine in Medford, N.J. Fortunately, the overwhelming majority of children are normal, he says. The pediatrician performs the development assessment as part of the well visit, billing the well-visit procedure and diagnosis codes.
 
Billing for the screening itself would probably be done using the office-visit codes, providing there is some indication of a problem, Scott says.

 
If a problem appears to be developing, more extensive screening is done, Scott says. Whether this screening is performed on the same day or scheduled for a different day will determine how the service is reported.
 
For example, a 6-month-old presents for a regular well visit. Everything was normal at the four-month visit, but the current visit will require additional and unexpected time, causing delays. You have a 15-minute scheduled appointment for the well visit, and you know any screening you do now will take at least an additional 20 minutes, Scott says. You can either bite the bullet and do it right then, getting behind in your schedule, or you can reschedule.
 
If the extra screening is performed that day, bill the well visit (99391) and the appropriate office visit with modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended. Link diagnosis code 783.4x (lack of expected normal physiological development in childhood) to the office visit. Note that the fifth digit is required: Use either 783.40 (... unspecified), 783.42 (... delayed milestones) or 783.43 (short stature).
 
On the other hand, the pediatrician might prefer to schedule the developmental screening for another day. Tell the mother, Lets do this later this week, when we wont be rushed, Scott says. Youre going to be doing a head-to-toe developmental screening on the child, and you want to make sure you set aside enough time.
 
Tip: This method works well any time a parent brings up potentially time-consuming issues during a well visit.
 
Code the stand-alone developmental screening 99214 or 99215, as supported by documentation, Scott recommends. This is a significant encounter, with important medical decision-making and examination elements as well as counseling time spent.

 
Codes 96110 (developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report) and 96111 (... extended [includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments, e.g., Bayley Scales of Infant Development] with interpretation and report, per hour) are neurology codes specifically for developmental testing and assessing cognition. Use 96110 for the Denver Developmental Assessment, Scott says.
 
Although a pediatrician could perform 96111, these tests are usually done by subspecialists -- neonatologists who are following low-birthweight babies after discharge, or developmental pediatricians, Scott says. I would ask the insurance company whether 96110 and 96111 are recognized for primary-care pediatricians before trying to bill them. I would also compare the fees for 99215 and 96110 and then decide which to bill.
 
You can bill for an E/M visit in addition to 96110 and 96111, but expect substantial variation among payer rules.

 
Regardless of which procedure code you use for the screening, use 783.4x for the diagnosis -- even if the screening results show that the child is normal. Select the diagnosis code based on the reason for the service, not on the final diagnosis. If the signs and symptoms showed a possible problem, use that diagnosis.