Pediatric Coding Alert

PEDS' creator shares 5 little-known facts about 96110

If you don't realize the extent of tests that CPT 96110 covers, your penny jar may not be filling up as fast as it should.

Medicare has allocated $10.34 for each unit of 96110 (2006 data). "This may seem like 'small change'" to some practices, says Frances Page Glascoe, PhD, PEDS developer and adjunct professor of pediatrics at Vanderbilt and Penn State Universities. But "if you have ever watched a 'penny jar' fill up, you'll understand how these small amounts can make a big impact over a year's revenue."

Understanding these nuances of 96110 (Developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report) will stop you from coming up short.

Fact 1: Well Child Diagnosis Applies to 96110

The American Academy of Pediatrics (AAP) has recommended that pediatricians start using 96110 for development screening testing involving a standardized instrument, says Bonnie Palmer, billing manager at Tots 'N' Teens in Hoffman Estates, Ill. Which diagnosis code would you use "if no problems were found along with a well baby checkup in which the patient was less than 1 year old?" she asks.

You should use well child exam code V20.2 with both the preventive medicine service code (99391, Periodic comprehensive preventive medicine reevaluation and management of an individual ...; infant [age under 1 year]) and the developmental screening code (96110), says Victoria S. Jackson, practice management consultant with JCM Inc. in California. In fact, you should always link 96110 to at least V20.2 (Routine infant or child health check), which indicates the reason the test was given. If a problem is found, also code the condition, such as 315.31 (Expressive language disorder).

Fact 2: Nonphysician Is Expected to Administer Test

Part of the reason 96110 is not valued higher is that it contains no physician relative work values. "CPT 96110 was developed to cover the service of a nonphysician administering a standardized screening instrument to the child's guardian or other observer," Glascoe says. "Administration," she says, can entail the nonphysician or the parent:

• reading the questions to an adult who is unable to read with comprehension at a fifth-grade level

• giving the instrument to the adult, explaining how to mark his answers and then letting him complete the forms independently (or answering specific questions as needed).

Fact 3: 96110 Isn't Limited to DDST-II

Numerous developmental screening instruments other than the Denver Developmental Screening Test II (DDST-II) qualify for 96110. "Code 96110 includes interpreting and reporting a multitude of tests, such as the DDST-II or the Early Language Milestone Screen," says David I. Berland, MD, American Academy of Child & Adolescent Psychiatry representative to the AMA CPT Advisory Committee. Some commonly used developmental screening instruments that are coded as 96110 include:

• Ages and Stages Questionnaire (ASQ) and Ages and States Questionnaire: Social and Emotional (ASQ:SE)
• Child Development Review
• Parents' Evaluation of Development Status (PEDS).

For further instrument examples, see the American Academy of Pediatrics (AAP) Developmental Testing/Screening "Coding Fact Sheet for Primary-Care Pediatricians" available on-line at http://www.gaaap.org/Coding-Compliance%20page/Developmental%20Screening-Testing%20Coding%20Fact%20Sheet.pdf.

Important: The list that appears on page 7 of the document is not all-inclusive, say Lynn Wegner, MD, FAAP, and Michelle Macias, MD, FAAP, in "Coding Conundrums: 96110 Developmental Testing; limited" published on www.dbpeds.org. The AAP included only "examples of standardized instruments used in 2005 when the fact sheet was written," the pediatricians say. Code 96110 may be appropriate for "any standardized instrument published."

Fact 4: Autism Screening Can Also Fall Under 96110

Although autism screening is usually limited to cases in which results from initial developmental screening indicate further testing is warranted, you don't need to seek another code for this additional service.

When you're assessing a baby for autism or ruling out autism in a patient, "the administration of these tests is pretty much subsumed under 96110," says Peter D. Rappo, MD, FAAP, assistant clinical professor of pediatrics at Harvard University School of Medicine in Brockton, Mass. "The code describes a number of different tools or vehicles, some that are global and some that are specific, which give a good sense of where a child is at," he says.

Possible autism screening tools that fall under 96110 include:

• Checklist for Autism in Toddlers (CHAT)
• Modified Checklist for Autism in Toddlers (M-CHAT)
• Pervasive Developmental Disorder Screening Test (PDDST-II Stage One).

Fact 5: 96110 x 2 Is Acceptable Coding

When a developmental screening raises concerns and you have staff follow up with an autism screening tool, make sure you use units to report both tests. "If giving something like PEDS and the M-CHAT, you should bill 96110 x 2 (two screens administered), in addition to the E/M code modified by 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service)," Glascoe says.

Watch out: You may need to use modifier 59 (Distinct procedural service) on same-day subsequent administration codes. Modifier 59 overrides most National Correct Coding Initiative (NCCI) edits making it useful and appropriate in many situations involving coding of multiple distinct procedures.

Wegner and Macias give the following example: A clinician uses several screening instruments, such as the Behavior Assessment for Children and the Behavior Rating Inventory for Executive Functions, for a single patient/family on a given date of service.

In this case, they state, "Appending each additional code 96110 reported with modifier 59 would correctly document this."