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 [...]